[Streptococcal mediastinitis after thyroidectomy. A literature review]

Area of Science:

• Infectious Diseases
• Surgical Complications
• Critical Care Medicine

Background:

• Surgical site infections (SSIs) following thyroidectomy are typically superficial.
• Mediastinitis caused by Streptococcus is a rare but severe complication.
• Prompt recognition and management are vital for patient outcomes.

Observation:

• A 57-year-old female developed severe symptoms 2 days post-thyroidectomy for Graves' disease.
• The patient presented with septic fever, elevated inflammatory markers, and erythema.
• A three-compartment infection involving Group A Streptococcus (GAS) and the mediastinum was diagnosed.

Findings:

• The patient underwent extensive treatment over 6 weeks, including seven surgical revisions under general anesthesia.
• Treatment involved pathogen-adapted antibiotics and negative pressure wound therapy.
• Published literature indicates a high mortality rate (11 out of 21 reported cases).

Implications:

• Post-thyroidectomy fever and erythema may signal GAS infection, potentially leading to necrotizing mediastinitis.
• Early diagnosis, aided by CT scans, is critical.
• Immediate interventions including surgical debridement, lavage, and antibiotics (penicillin and clindamycin) are essential.
• Negative pressure therapy is a valuable option for refractory cases.