Mediastinitis complicating cervical cellulitis in a diabetic patient

Houas Jihene; Bergaoui Emna; Ghammam Monia; Naouar Maroua; Malika El Omri; Bellakhdher Mouna; Abed Yosra Hasni El; Meherzi Abir; Kermani Wassim; Abdelkefi Mohamed

doi:10.1530/endoabs.90.EP547

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Endocrine Abstracts (2023) 90 EP547 | DOI: 10.1530/endoabs.90.EP547

ECE2023 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (355 abstracts)

Mediastinitis complicating cervical cellulitis in a diabetic patient

Houas Jihene ¹ , Bergaoui Emna ¹ , Ghammam Monia ¹ , Naouar Maroua ¹ , El Omri Malika ¹ , Bellakhdher Mouna ¹ , Hasni El Abed Yosra ² , Meherzi Abir ¹ , Kermani Wassim ¹ & Abdelkefi Mohamed ¹

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¹ENT Department and Neck Surgery of Farhat Hached Hospital, Sousse, Tunisia; ²Endocrinology Department Farhat Hached Hospital, Sousse, Tunisia.

Introduction: Cervicofacial cellulitis represents one of the most worrying infectious emergencies in ENT despite their frequency which has clearly decreased since the advent of antibiotics. From a simple infection, most often dental or in the ENT sphere, it produces an infiltration of the cellulo-adipose tissue of the face and neck with extensive necrosis of the cervical and even mediastinal aponeurotic spaces especially in diabetic patients. The management must be rapid and efficient since the vital prognosis is engaged.

Aim: To study the clinical, radiological and the therapeutic modalities of mediastinitis complicating cervico-facial cellulitis in a diabetic patient.

Observation: This is a 62-year-old diabetic man, who consults ENT emergency for a left cervical mass associated with fever and asthenia since 2 days. Respiratory and hemodynamic status were preserved. The oral examination showed a defect oral hygiene with a decayed of the 41 tooth. The left cervical swelling was 10 cm, indurated and with inflammatory signs. The initial biological assessment shows a hyper leukocytosis at 327OO, a CRP at 319 mg/l and a blood sugar level at 12 mmol/l. Cervico-thoracic scan reveals a collection in the left anterolateral cervical spaces with wide pharyngeal communication, piriform sinus, extending to the thyroid cartilage taking off the thyroid gland, perioesophageal and reaching the anterior and posterior mediastinum. The dental panoramic shows a deterioration of the 41. An emergency flattening was performed after notifying cardiovascular surgeons for a possible thoracotomy. Bacteriological examination showed a very abundant and mixed bacterial flora reminiscent of anaerobic germs. Bi-antibiotic was initiated immediately. The dental treatment was carried out. Postoperative follow-up showed an improvement of the local condition and normalization of the inflammatory assessment.

Conclusion: Cervical cellulitis in diabetics is a serious condition requiring urgent and multidisciplinary care. The clinical presentation may sometimes underestimate the extent of the infection, causing life-threatening mediastinitis.