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Mediastinitis presenting as pyrexia of unknown origin
Summary
A 55-year-old female with pyrexia of unknown origin (PUO) presented with neck swelling and respiratory symptoms. Prompt antibiotic and steroid treatment led to complete resolution of mediastinitis and pleural effusion.
Area of Science:
- Infectious Diseases
- Radiology
- Internal Medicine
Background:
- Pyrexia of unknown origin (PUO) presents a diagnostic challenge.
- Mediastinitis and pleural effusion can arise from various infectious or inflammatory processes.
Observation:
- A 55-year-old female with a 2-month history of PUO developed acute symptoms including throat ache, dysphagia, cough, and chest pain.
- Physical examination revealed fever, tachycardia, tachypnea, and a tender erythematous neck swelling, with chest findings suggestive of bilateral pleural effusion.
Findings:
- Radiological imaging, including X-rays and CT scans, confirmed cellulitis of the lower neck, bilateral pleural effusion, pericardial effusion and thickening, mediastinal lymphadenopathy, and mediastinitis.
- The patient responded favorably to parenteral antibiotics (ceftriaxone and metronidazole) and hydrocortisone therapy.
Implications:
- This case highlights the importance of a comprehensive diagnostic approach in PUO.
- Early recognition and aggressive management with antibiotics and corticosteroids can lead to successful outcomes in complex cases of mediastinitis and associated effusions.