Nei Takahito, Inai Shunta, Mikami Iwao, Sato Akira, Okamoto Junichi, Yokoshima Kazuhiko, Nakamizo Munenaga, Haraguchi Shuji, Sonobe Kazunari, Saito Ryoichi
Department of Infection Control and Prevention, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
BMC Infect Dis. 2013 Aug 29;13:398. doi: 10.1186/1471-2334-13-398.
Descending necrotizing mediastinitis (DNM), a severe infection with a high fatality rate, develops in mediastinal spaces due mainly to deep cervical abscesses. The majority of causative microbes of DNM are Streptococci and oral anaerobes. DNM associated with Lactobacillus-infection is rather rare.
A 69-year-old male with an unremarkable past medical history was referred to our hospital for surgical resection of advanced laryngeal cancer. Full examination revealed a neck abscess and DNM with a background of untreated diabetes mellitus. Initially, he was treated with meropenem. However, Lactobacillus plantarum was isolated from surgical drainage of a mediastinal abscess. Despite using antibiotics capable of eradicating all isolates with susceptibilities not differing significantly from those of the neck and mediastinal abscesses, we attributed DNM to the L. plantarum detected only in the mediastinal abscess. After DNM treatment, he underwent total pharyngolaryngectomy with bilateral neck dissection followed by reconstruction using free jejunum. He was discharged fully recovered.
We concluded that L. plantarum as the sole cause of the mediastinal abscess in the present case cannot be ruled out. As the number of immunocompromised patients increases, we should be cautious regarding this "familiar" microbe.
下行性坏死性纵隔炎（DNM）是一种死亡率很高的严重感染，主要由深部颈部脓肿引起，在纵隔间隙中发展。DNM的大多数致病微生物是链球菌和口腔厌氧菌。与乳酸杆菌感染相关的DNM相当罕见。
一名69岁男性，既往病史无异常，因晚期喉癌手术切除被转诊至我院。全面检查发现颈部脓肿和DNM，伴有未治疗的糖尿病。最初，他接受美罗培南治疗。然而，从纵隔脓肿的手术引流物中分离出植物乳杆菌。尽管使用了能够根除所有分离菌且药敏情况与颈部和纵隔脓肿无显著差异的抗生素，但我们将DNM归因于仅在纵隔脓肿中检测到的植物乳杆菌。DNM治疗后，他接受了全喉咽切除术加双侧颈清扫术，随后用游离空肠进行重建。他康复出院。
我们得出结论，在本病例中不能排除植物乳杆菌是纵隔脓肿的唯一病因。随着免疫功能低下患者数量的增加，我们应对这种“常见”微生物保持谨慎。
