Delayed presentation of deep sternal wound infection

Deep sternal wound infections (DSWI) are infections of the sternum, mediastinum, or the muscle, fascia and soft tissue that overlie the sternum, typically occurring within a month of cardiac surgery. They are infrequent though severe complications of cardiac surgery. Diagnosis is made by the clinical presentation of fever, chest pain, or sternal instability in the setting of wound drainage, positive wound cultures, or chest radiographic findings. We describe the case of an elderly man presenting 6 months after cardiac surgery with DSWI. Due to the atypical nature of such a late presentation, definitive therapy was delayed. Given a severely ill patient with multiple risk factors for poor wound healing, the clinician must maintain a high index of suspicion for DSWI despite a delayed presentation.