A Case of Mediastinitis Due to Fulminant Group A Streptococcal Infection

Mediastinitis caused by group A Streptococcus (GAS) is extremely rare and often progresses rapidly, with high mortality.

A 43-year-old man with no significant medical history developed a sore throat. Several days later, he presented to a local clinic with a high-grade fever of 40°C and chest pain. He was initially advised to rest under observation, but his symptoms persisted. Two days later, he sought care at a nearby hospital, where chest CT revealed findings suggestive of mediastinitis. He was subsequently transferred to our hospital for emergency treatment. On arrival, he was in circulatory shock and showed signs of multiple organ dysfunction. Laboratory tests revealed markedly elevated inflammatory markers, including a C-reactive protein level of 40.0 mg/dL. Emergency surgical drainage of a mediastinal abscess was performed, followed by intensive care and antimicrobial therapy. Blood and pleural fluid cultures identified GAS as the causative organism. The patient's condition gradually improved with continued systemic management. He was discharged from the ICU and began rehabilitation. Despite developing complications such as fingertip necrosis and delayed wound healing, he regained independent mobility. The patient was transferred to a rehabilitation facility on POD 48.

This case highlights the importance of early recognition and immediate surgical and medical intervention in treating fulminant mediastinitis caused by GAS. Prompt and aggressive management can result in favorable outcomes, even in cases presenting with shock and multi-organ failure.