Infectious Mediastinitis and Pericarditis after Endobronchial Ultrasound-guided Intranodal Forceps Biopsy: A Case Report

Abstract

Endobronchial ultrasound (EBUS) -guided intranodal forceps biopsy (EBUS-IFB) has gained attention as a complementary procedure to improve the diagnostic yield and tissue acquisition of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) in thoracic lymphadenopathy. Despite the promise of EBUS-IFB, its safety profile remains underreported, with no serious infections documented. We present a case of infectious mediastinitis and pericarditis following EBUS-IFB. A 54-year-old man underwent EBUS-TBNA and EBUS-IFB for the diagnosis of squamous cell carcinoma. Despite prophylactic antibiotics, 25 days after the procedure, the patient developed fever, tachycardia, and hypotension, and was diagnosed with infectious mediastinitis and pericarditis. Pericardial drainage and antibiotic therapy were administered, and the patient recovered after pericardial window surgery. This case highlights the potential for infectious complications with EBUS-IFB, underscoring the need for further investigation into risk factors and optimal procedural techniques for mitigating infection risk. Awareness of these complications is crucial in improving patient outcomes, particularly in high-risk individuals undergoing EBUS procedures.