Yoshimura Miki, Daifu Tomoo, Suehiro Minoru, Shoji Tsuyoshi, Higuchi Yoshihisa
Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan.
Department of Thoracic Surgery, Otsu Red Cross Hospital, Otsu 520-8511, Japan.
Pediatr Rep. 2022 Dec 27;15(1):16-19. doi: 10.3390/pediatric15010003.
Descending necrotizing mediastinitis (DNM) is a severe, life-threatening disease with a high mortality rate resulting from sepsis or other complications. DNM can also be a rare and severe complication of Epstein-Barr virus (EBV) infection in adolescents and young adults but has never been reported in a pre-school child. A 4-year-old girl was admitted to our hospital with a 2-day history of fever and chest pain. Computed tomography (CT) revealed a right sided pleural effusion, fluid collection in the retropharyngeal and mediastinal areas, cervical lymphadenopathy, and marked hepatosplenomegaly. She was diagnosed with empyema, retropharyngeal abscess, and mediastinitis. To improve her dyspnea, a chest tube was inserted, and antibiotic treatment was initiated. Her condition improved temporarily, but on day 5 in our hospital, she developed a fever again. A repeat CT scan showed exacerbation of fluid retention in the retropharyngeal area and the mediastinum, for which she underwent drainage and debridement of necrotic tissue in the retropharynx and mediastinum. The presence of cervical lymphadenopathy and marked hepatosplenomegaly suggested the involvement of EBV. Serological tests for EBV revealed primary EBV infection at the time of the DNM onset. Finally, she was diagnosed with DNM following primary EBV infection. At follow-up 1 year later, she was doing well. The risk of DNM should be recognized in patients, even pre-school aged children, with primary EBV infection.
下行性坏死性纵隔炎（DNM）是一种严重的、危及生命的疾病，因败血症或其他并发症导致死亡率很高。DNM也可能是青少年和青年中爱泼斯坦-巴尔病毒（EBV）感染的一种罕见且严重的并发症，但学龄前儿童中从未有过报道。一名4岁女孩因发热和胸痛2天入住我院。计算机断层扫描（CT）显示右侧胸腔积液、咽后和纵隔区域积液、颈部淋巴结肿大以及明显的肝脾肿大。她被诊断为脓胸、咽后脓肿和纵隔炎。为改善她的呼吸困难，插入了胸管并开始抗生素治疗。她的病情暂时好转，但在我院住院第5天，她再次发热。重复CT扫描显示咽后区域和纵隔的积液加重，为此她接受了咽后和纵隔坏死组织的引流和清创术。颈部淋巴结肿大和明显的肝脾肿大提示EBV感染。EBV的血清学检测显示在DNM发病时为原发性EBV感染。最后，她被诊断为原发性EBV感染后发生的DNM。1年后随访时，她情况良好。对于原发性EBV感染的患者，即使是学龄前儿童，也应认识到DNM的风险。
