Kobayashi Ken-Ichiro, Kubo Kenji, Komiya Nobuhiro
Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Japan.
IDCases. 2025 Aug 20;41:e02351. doi: 10.1016/j.idcr.2025.e02351. eCollection 2025.
Descending necrotizing mediastinitis (DNM), a severe complication arising from deep neck infection, developed in an obese 45-year-old Japanese male with diabetes. His condition was caused by a Group A Streptococcus (GAS) infection that arose following an earlier influenza A infection during a seasonal influenza outbreak. The patient had a good clinical course with surgical drainage and debridement with antibiotic treatment. Pre-existing medical conditions and co-infections such as influenza increase susceptibility to GAS infection, and invasive GAS infection leads to increased mortality. The patient initially presented with fever, sore throat, and cough following influenza A infection, symptoms that were difficult to distinguish from those of deep neck infection caused by GAS. As the GAS was detected in blood cultures, the initial diagnosis was primary bacteremia following influenza A. Subsequently, however, the appearance of erythema on the anterior neck and around the thyroid cartilage suggested a descending progression of the infection from the deep neck space. Contrast-enhanced CT led to a diagnosis of DNM. The reported cases of DNM associated with viral infections have so far been limited to those following varicella or Epstein-Barr virus (EBV) infection. To our knowledge, this is the first reported case of DNM caused by GAS associated with influenza A infection. DNM caused by GAS is a rare infection that requires prompt surgical intervention followed by thorough systemic management. Clinicians should carefully monitor patients with underlying medical conditions who manifest recurrent or new symptoms such as fever, sore throat, and dyspnea after influenza infection.
下行性坏死性纵隔炎（DNM）是一种由深部颈部感染引起的严重并发症，发生在一名患有糖尿病的45岁肥胖日本男性身上。他的病情是由甲型流感季节性暴发期间先前感染甲型流感后出现的A组链球菌（GAS）感染所致。患者通过手术引流、清创术及抗生素治疗，临床过程良好。如流感等既存疾病和合并感染会增加对GAS感染的易感性，而侵袭性GAS感染会导致死亡率上升。患者在感染甲型流感后最初出现发热、咽痛和咳嗽，这些症状难以与GAS引起的深部颈部感染症状相区分。由于血培养中检测到GAS，最初诊断为甲型流感后的原发性菌血症。然而，随后前颈部和甲状软骨周围出现红斑，提示感染从深部颈部间隙呈下行性进展。增强CT检查确诊为DNM。迄今为止，报道的与病毒感染相关的DNM病例仅限于水痘或爱泼斯坦-巴尔病毒（EBV）感染后的病例。据我们所知，这是首例由与甲型流感感染相关的GAS引起的DNM报道病例。由GAS引起的DNM是一种罕见感染，需要及时进行手术干预，随后进行全面的全身治疗。临床医生应仔细监测患有基础疾病且在流感感染后出现发热、咽痛和呼吸困难等复发或新症状的患者。
