FROM THE MOUTH TO THE MEDIASTINUM: DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO AN ODONTOGENIC ABSCESS: A CASE REPORT

Descending necrotizing mediastinitis (DNM) is a rare but potentially fatal infection, usually secondary to deep odontogenic infections. Its rapid progression through the deep cervical spaces into the mediastinum requires timely diagnosis, early control of the infectious focus, and multidisciplinary management.
We present the case of a 20-year-old male patient from a rural area, with no relevant medical history, no history of substance abuse, HIV-negative, and no evidence of diabetes mellitus or other immunosuppressive factors. He presented with a seven-day history of molar pain associated with progressive edema, unquantified fever, and subsequently dysphagia with deterioration of his general condition. Upon admission, he exhibited a systemic inflammatory response with predominantly neutrophilic leukocytosis, elevated C-reactive protein and procalcitonin, with preserved renal and hepatic function. A cervical computed tomography scan revealed an odontogenic abscess with gas in the deep tissues of the neck. Initial treatment included tooth extraction, abscess drainage, cervicotomy with debridement and cervical lavage, and broad-spectrum antibiotic therapy. Due to persistent fever and unfavorable evolution, a follow-up CT scan showed extension of the infection to the mediastinum, classified as descending necrotizing mediastinitis type IIA according to Endo. Mediastinal drainage was performed via video-assisted thoracoscopic surgery (VATS), along with pleural drainage for empyema. During the procedure, the patient developed septic shock requiring vasopressors and was admitted to the intensive care unit, with subsequent favorable evolution following comprehensive management.
This case highlights that MND can occur in young, immunocompetent patients and demonstrates the importance of early diagnosis, a multidisciplinary approach, and the use of minimally invasive techniques such as VATS to achieve adequate infection control and a satisfactory outcome.