2017 Volume 39 Issue 5 Pages 418-423
Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to be a useful and safe diagnostic method, but recently there have been some reports of EBUS-TBNA-induced mediastinitis. Case. A 67-year-old man presented with a nodule in the right lower lobe and mediastinal lymphadenopathy (#7 lymph node), we suspected lung cancer. EBUS-TBNA was performed on the #7 lymph node. The patient developed a fever 2 days after the procedure. Chest computed tomography (CT) showed enlargement and inflammation of the mediastinum 5 days after the procedure, based on which acute mediastinitis was diagnosed. A therapeutic antibiotic regimen was commenced; however, mediastinitis developed on the 8 days after the EBUS-TBNA. Drainage was subsequently performed, and an antibiotic regimen continued for about 6 weeks, by the end of which the patient recovered. A mediastinal effusion culture revealed Streptococcus constellatus of Streptococcus milleri group (SMG), form part of the normal flora commonly found in the mouth. Conclusion. We reported a case of mediastinitis caused by SMG after EBUS-TBNA. In cases where there is an EBUS-TBNA of necrotic lymph nodes or failure of oral hygiene, prophylactic antibiotic use or oral care should be considered to prevent mediastinitis.
