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Descending Necrotizing Mediastinitis Initially Misinterpreted as a Musculoskeletal Disorder: A Case Report

Year: 2026

Type: article

Abstract: Descending necrotizing mediastinitis (DNM) is a rare but life‐threatening infection in which early diagnosis is critical, although atypical symptoms and subtle initial imaging findings may delay recognition. We report a 57‐year‐old man with diabetes mellitus who presented with fever and severe right posterior neck pain radiating to the shoulder, initially leading to orthopedic evaluation; the pain was disproportionately severe relative to physical findings and refractory to analgesics, with retrosternal tenderness. Laboratory tests showed elevated C‐reactive protein with mild leukocytosis, thrombocytopenia, hypoalbuminemia, and coagulopathy, while initial noncontrast CT showed subtle findings, including pleural effusion and increased retrosternal soft tissue density. Contrast‐enhanced CT the following day revealed a mediastinal abscess, and blood cultures yielded methicillin‐susceptible Staphylococcus aureus ; the patient improved with antimicrobial therapy without surgical drainage. This case highlights that unexplained severe pain disproportionate to physical findings should prompt consideration of deep‐seated infection and timely contrast‐enhanced imaging when DNM is suspected.

Source: Case Reports in Infectious Diseases

DOI: 10.1155/crdi/5848006