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Peer-reviewedCC BYCase reports in infectious diseases

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

  • Yudai Kaneda1
  • Kenji Gonda2
  • Akihiko Ozaki2
  • Toyoaki Sawano3
  • Tomohiro Kurokawa3
  • Mitsuro Fukuhara4
  • Hiroaki Shimmura5
5 affiliations
  1. 1Clinical Training Center Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan.
  2. 2Department of Breast and Thyroid Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan.
  3. 3Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan.
  4. 4Department of Chest Surgery Iwaki City Medical Center Iwaki Fukushima Japan.
  5. 5Department of Urology Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan dlut.edu.cn.
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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.

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Cite

BibTeXRIS
BibTeX
@article{kaneda2026descending,
  title = {{Descending Necrotizing Mediastinitis Initially Misinterpreted as a Musculoskeletal Disorder: A Case Report.}},
  author = {Yudai Kaneda and Kenji Gonda and Akihiko Ozaki and Toyoaki Sawano and Tomohiro Kurokawa and Mitsuro Fukuhara and Hiroaki Shimmura},
  journal = {Case reports in infectious diseases},
  year = {2026},
  month = nov,
  doi = {10.1155/crdi/5848006},
  url = {https://europepmc.org/article/MED/42996893},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Descending Necrotizing Mediastinitis Initially Misinterpreted as a Musculoskeletal Disorder: A Case Report.
AU  - Yudai Kaneda
AU  - Kenji Gonda
AU  - Akihiko Ozaki
AU  - Toyoaki Sawano
AU  - Tomohiro Kurokawa
AU  - Mitsuro Fukuhara
AU  - Hiroaki Shimmura
PY  - 2026
DA  - 2026/11/05
JO  - Case reports in infectious diseases
DO  - 10.1155/crdi/5848006
UR  - https://europepmc.org/article/MED/42996893
AB  - 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.
SN  - 2090-6625
SN  - 2090-6633
ER  -