Methicillin-resistant staphylococcus aureus descending necrotizing mediastinitis in an infant

Introduction: Descending necrotizing mediastinitis (DNM) can be a deadly medical emergency that is not well described in pediatric patients. Usually stemming from an oropharyngeal infection, it can spread rapidly to the mediastinum through the alar fascia known as the "danger space." Methods: We describe a rare case of a 4-month-old female who was found to have a complicated oropharyngeal MRSA infection leading to DNM. Contrast-enhanced computed tomography showed an extensive oropharyngeal abscess that spanned from her skull base to the mediastinum, encasing her the neurovascular bundle of the carotid sheath, as well as the great vessels of the aorta. An associated large right pleural effusion also complicated her case. Results: The patient was treated with antibiotic therapy, multiple operative drainages of her supraclavicular abscesses, and tube thoracostomy. She was able to make a full recovery and was discharged with a course of antibiotics. Conclusion: DNM is a rare, but potentially deadly, complication of oropharyngeal infection. Surgical intervention, along with antibiotic therapy, must be considered if the severity of DNM is extensive. Clinicians must have a high index of suspicion for DNM when pediatric patients present with a severe oropharyngeal infection, especially with the rise of MRSA associated infections.