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A case of mediastinitis accompanied with hyperosmolar nonketotic coma

View Article: PubMed Central - PubMed

ABSTRACT

Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling.

No MeSH data available.


Related in: MedlinePlus

Cervicothoracic CT showing gas and abscess formation in upper mediastinum on both sides of the neck and pleural effusion in both hemithorax.
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fig1: Cervicothoracic CT showing gas and abscess formation in upper mediastinum on both sides of the neck and pleural effusion in both hemithorax.

Mentions: A 61-year-old male diabetic patient was admitted to the emergency department with complaints of generalized worsening, fever, dysphagia and cervical swelling for 7 days. He had a history of impacted fish bones in his throat one week ago. He was examined by the endoscopist and given oral antibiotics but no improvement was observed. Physical examination revealed dysphagia, dysphonia, and cough, in addition to deterioration of general condition. The patient's body temperature was 39 °C. Laboratory tests showed a white blood cell count of 18,900/mm3, a hemoglobin level of 11.3 g/dL, CRP 64 ng/ml (normal range 0–5), plasma glucose level 680 mg/dl, pH:7,4 and plasma osmolarity 320 mOsm/kg. He was diagnosed as nonketotic hyperosmolar coma and taken into the intensive care unit. Intravenous insulin and % 0,9 NaCl administered immediately with a wide spectrum prophyactic antibiotic, ceftriaxon 2 gr/day intravenously. His fever was remained high after three days. A neck ultrasound examination, due to neck pain, revealed an abscess formation in the upper mediastinum with a close relation to thyroid gland. A cervicothoracic computed tomography (CT) revealed gas and abscess formation in upper mediastinum on the both side of the neck and pleural effusion in the both hemithorax (Fig. 1). Gram stain of the needle aspiration in his neck showed polymorphonuclear leukocytes existence, and no bacteria. The needle aspirat culture failed to show bacterial growth. Thus, ceftriaxon was discontinued and meropenem 3 gr/day intravenously was started. After five days of antibiotic treatment the patient's symptoms resolved. A control cervicothoracic CT was taken on 10th day. The abscess formation and pleural effusion almost disappeared (Fig. 2). Fifteen days following admittance, the patient was discharged.


A case of mediastinitis accompanied with hyperosmolar nonketotic coma
Cervicothoracic CT showing gas and abscess formation in upper mediastinum on both sides of the neck and pleural effusion in both hemithorax.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121274&req=5

fig1: Cervicothoracic CT showing gas and abscess formation in upper mediastinum on both sides of the neck and pleural effusion in both hemithorax.
Mentions: A 61-year-old male diabetic patient was admitted to the emergency department with complaints of generalized worsening, fever, dysphagia and cervical swelling for 7 days. He had a history of impacted fish bones in his throat one week ago. He was examined by the endoscopist and given oral antibiotics but no improvement was observed. Physical examination revealed dysphagia, dysphonia, and cough, in addition to deterioration of general condition. The patient's body temperature was 39 °C. Laboratory tests showed a white blood cell count of 18,900/mm3, a hemoglobin level of 11.3 g/dL, CRP 64 ng/ml (normal range 0–5), plasma glucose level 680 mg/dl, pH:7,4 and plasma osmolarity 320 mOsm/kg. He was diagnosed as nonketotic hyperosmolar coma and taken into the intensive care unit. Intravenous insulin and % 0,9 NaCl administered immediately with a wide spectrum prophyactic antibiotic, ceftriaxon 2 gr/day intravenously. His fever was remained high after three days. A neck ultrasound examination, due to neck pain, revealed an abscess formation in the upper mediastinum with a close relation to thyroid gland. A cervicothoracic computed tomography (CT) revealed gas and abscess formation in upper mediastinum on the both side of the neck and pleural effusion in the both hemithorax (Fig. 1). Gram stain of the needle aspiration in his neck showed polymorphonuclear leukocytes existence, and no bacteria. The needle aspirat culture failed to show bacterial growth. Thus, ceftriaxon was discontinued and meropenem 3 gr/day intravenously was started. After five days of antibiotic treatment the patient's symptoms resolved. A control cervicothoracic CT was taken on 10th day. The abscess formation and pleural effusion almost disappeared (Fig. 2). Fifteen days following admittance, the patient was discharged.

View Article: PubMed Central - PubMed

ABSTRACT

Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling.

No MeSH data available.


Related in: MedlinePlus