Cardiac tamponade due to group a streptococcus descending necrotizing mediastinitis: case report of an unusual presentation

Abstract

Background: Cardiac tamponade from necrotizing descending mediastinitis is a rare but life-threatening complication of cervicofacial infections.

Case report: A 49-year-old woman presented in shock with pleuretic chest pain at a small community clinic. She was transferred to our emergency department where cardiac tamponade was diagnosed and drained. Her initial complete blood count and chest radiography suggested a neoplastic process. She, however, was diagnosed with descending necrotizing mediastinitis due to group A Streptococcus. She underwent surgical drainage and recovered uneventfully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Descending necrotizing mediastinitis can present with cardiac tamponade and a leukemoid reaction mimicking a neoplastic process. Recognizing this entity allows initiation of potentially life-saving treatments.

Keywords: cardiac tamponade; cervicofacial infection; descending necrotizing mediastinitis; leukemoid reaction; pericardial effusion.