Infectious Mononucleosis Resulting in Acute Necrotizing Mediastinitis: A Case Report and Literature Review

Héloïse Van Noten; Samuel Markowicz; Serge Cappeliez; Soraya Cherifi

doi:10.12890/2020_001829

Infectious Mononucleosis Resulting in Acute Necrotizing Mediastinitis: A Case Report and Literature Review

Eur J Case Rep Intern Med. 2020 Aug 24;7(11):001829. doi: 10.12890/2020_001829. eCollection 2020.

Authors

Héloïse Van Noten¹, Samuel Markowicz¹, Serge Cappeliez², Soraya Cherifi¹

Affiliations

¹ Internal Medicine and Infectious Diseases Department, C.H.U de Charleroi, Lodelinsart, Belgium.
² Cardio-Thoracic Surgery Department, C.H.U de Charleroi, Lodelinsart, Belgium.

Abstract

The serological prevalence of Epstein-Barr virus (EBV) among young adults exceeds 90% worldwide. Even though EBV primary infection is usually benign, severe complications can occur in adolescents and young adults and so the disease must be promptly diagnosed. The development of an oropharyngeal abscess leading to a descending necrotizing mediastinitis (DNM) is exceptional and potentially lethal, so early diagnosis with a CT scan, appropriate antibiotics and surgery are essential. The authors present a case where DNM was associated with reactive hemophagocytic syndrome as a result of infectious mononucleosis, as well as a review of similar cases in the English literature.

Learning points: The incidence of serious complications in Epstein-Barr virus (EBV) primary infection increases with age.Respiratory symptoms (e.g., pleuritic pain, dyspnoea) and unusually prolonged fever (>10 days) in patients with infectious mononucleosis could be 'red flags' for life-threatening complications such as empyema and descending necrotizing mediastinitis.The threshold for performing cervical and chest computed tomography in septic patients with infectious mononucleosis should be low.

Keywords: Epstein-Barr virus; descending necrotizing mediastinitis; infectious mononucleosis; reactive hemophagocytic syndrome; retropharyngeal abscess.