Deep cervical cellulitis with mediastinal and retroperitoneal extension aggravated by non-steroidal anti-inflammatory drugs: A challenging case report

Background: Cervicofacial and deep cervical cellulitis represent severe, life-threatening infectious emergencies of the head and neck. The inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain management is widely recognized as a major risk factor that masks symptoms, promotes rapid tissue destruction, and accelerates deep fascial, mediastinal, and retroperitoneal extension.
Case Presentation: We report the case of a 45-year-old female with no significant prior medical history who presented with an acute ankle sprain treated medically with analgesics and NSAIDs. Three days later, she developed a painful, warm, and inflammatory left laterocervical swelling with no obvious ear, nose, and throat (ENT) or dental portal of entry. Biological evaluations revealed a prominent inflammatory syndrome. Contrast-enhanced cervico-thoracic computed tomography (CT) demonstrated left laterocervical cellulitis exerting mass effect on the upper aero-digestive tract, extending inferiorly into the mediastinum and downwards into the retroperitoneum, accompanied by a small venous thrombosis involving the initial portions of the left internal jugular vein and the left subclavian vein. The patient was successfully managed with broad-spectrum intravenous antibiotic therapy and corticosteroids, resulting in significant clinical, biological, and radiological improvement.
Conclusion: Deep cervical cellulitis extending beyond the cervicothoracic junction into the mediastinum and retroperitoneum is an exceptionally rare and critical condition. This case underscores the detrimental role of NSAIDs in exacerbating deep neck infections and highlights the efficacy of prompt medical therapy and close monitoring in achieving favorable outcomes.