A case of spontaneous perforation of the hypopharynx accompanied by acute mediastinitis is reported. An 8-year-old male was admitted to our hospital for sudden dyspnea. On admission, he had a low grade fever, subcutaneous emphysema, and pneumomediastinum. The next day, C-reactive protein values were markedlyelevated. Radiographic findings showed dilatation of the right upper mediastinum and leakage of contrast material from the right piriform sinus or just below it. As no underlying disease was present and his history was unremarkable, neither chest trauma nor a foreign body was considered likely. Spontaneous perforation was suspected. Hypopharyngeal or esophageal perforation should be considerd in a patient presenting with pneumomediastinum and findings of severe inflammation. Early diagnosis and treatment of acute mediastinitis are essential for lifesaving.
A 57-year-old woman was admitted to our hospital with fever and lethargy. Cerebrospinal fluid (CSF) examination revealed pleocytosis and increased protein content. Immunological testing was positive for anti-herpes simplexvirus antibody and anti-cytomegalovirus antibody in each titer. Viral encephalitis was diagnosed and the patientwas initially treated with acyclovir, but was completely unresponsive to the drug. Since acyclovir was ineffective, the patient was switched to ganciclovir. This was followed by fever reduction and a decrease in CSF cell count. Theetiology of the encephalitis in this case was thought to be infection by acyclovir-resistant herpes simplex virus, ormixed infection by acyclovir-resistant herpes simplex virus and cytomegalovirus. When acyclovir is ineffective inviral encephalitis, ganciclovir may be the treatment of choice.