Infectious Mononucleosis Resulting in Acute Necrotizing Mediastinitis: A Case Report and Literature Review

The serological prevalence of Epstein-Barr virus (EBV) among young adults exceeds 90% worldwide. Even though EBV primary infection is usually benign, severe complications can occur in adolescents and young adults and so the disease must be promptly diagnosed. The development of an oropharyngeal abscess leading to a descending necrotizing mediastinitis (DNM) is exceptional and potentially lethal, so early diagnosis with a CT scan, appropriate antibiotics and surgery are essential. The authors present a case where DNM was associated with reactive hemophagocytic syndrome as a result of infectious mononucleosis, as well as a review of similar cases in the English literature.

The incidence of serious complications in Epstein-Barr virus (EBV) primary infection increases with age.Respiratory symptoms (e.g., pleuritic pain, dyspnoea) and unusually prolonged fever (>10 days) in patients with infectious mononucleosis could be 'red flags' for life-threatening complications such as empyema and descending necrotizing mediastinitis.The threshold for performing cervical and chest computed tomography in septic patients with infectious mononucleosis should be low.