Journal article
Mediastinal Abscess and Bacteremia Due to Streptococcus dysgalactiae Complicated by Aorto-esophageal Fistula Leading to Death with Massive Bleeding in a 70-Year-Old Japanese Man with Gastric Cancer
IDCases, Vol.38, e02078
09/2024
DOI: 10.1016/j.idcr.2024.e02078
PMCID: PMC11416686
PMID: 39309038
Abstract
Streptococcus dysgalactiae can lead to bacteremia in elderly individuals with underlying conditions, primarily from cellulitis. Although rare, mediastinal abscesses can develop from anatomical anomalies, post-thoracic surgery, esophageal rupture, or inflammation in the oral cavity or neck. Aorto-esophageal fistula, a life-threatening condition causing severe bleeding, typically arises from thoracic aortic aneurysms with atherosclerosis. We present a case of recurrent Streptococcus dysgalactiae bacteremia complicated by mediastinal abscess and aorto-esophageal fistula in a patient undergoing treatment for gastric cancer. Initial imaging suggested lymph node metastasis, with a diagnosis of abscess only confirmed at autopsy. Although the exact etiology of the abscess was unclear, we highly suspect the recurrent Streptococcus dysgalactiae bacteremia contributed to its development via hematogenous spread. Autopsy also revealed progression of the mediastinal abscess into the esophagus and aorta, leading to the formation of a fistula, massive hemorrhage, and ultimately, the patient’s death. While uncommon, a mediastinal abscess should be recognized as a potential cause of aorto-esophageal fistula.
Details
- Title: Subtitle
- Mediastinal Abscess and Bacteremia Due to Streptococcus dysgalactiae Complicated by Aorto-esophageal Fistula Leading to Death with Massive Bleeding in a 70-Year-Old Japanese Man with Gastric Cancer
- Creators
- Kazuya Oshima - Kameda Medical CenterYoshiya Sugano - Kameda Medical CenterAkihito Yoshida - Kameda Medical CenterWataru Uegami - Kameda Medical CenterNicholas Van Sickels - University of KentuckyTakaaki Kobayashi - University of KentuckyTadashi Eguchi - Kameda Medical Center
- Resource Type
- Journal article
- Publication Details
- IDCases, Vol.38, e02078
- Publisher
- ELSEVIER SCI LTD; London
- DOI
- 10.1016/j.idcr.2024.e02078
- PMID
- 39309038
- PMCID
- PMC11416686
- ISSN
- 2214-2509
- eISSN
- 2214-2509
- Language
- English
- Date published
- 09/2024
- Academic Unit
- Infectious Diseases; Internal Medicine
- Record Identifier
- 9984702949902771
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