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Periapical abscess progressing to parotitis and descending necrotizing mediastinitis with thoracic abscess in a patient on etanercept: A case report

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Patients on Type 2 biologics, such as etanercept, are at increased risk for aggressive infections. This may be further exacerbated by concomitant systemic corticosteroid use or comorbidities such as diabetes.… Click to show full abstract

Patients on Type 2 biologics, such as etanercept, are at increased risk for aggressive infections. This may be further exacerbated by concomitant systemic corticosteroid use or comorbidities such as diabetes. We report a case of a patient with rheumatoid arthritis on etanercept with poor dentition and periodontal disease, who developed parotitis with peritonsillar abscess and descending necrotizing mediastinitis (DNM) with periaortic abscess arising from a periapical abscess. Morbidity and mortality of such infections is high. A multimodal assessment and treatment team is required to optimize patient survival and outcomes. This manuscript discusses the diagnostic and treatment challenges of DNM of immunocompromised patients.

Keywords: periapical abscess; abscess; necrotizing mediastinitis; report; case; descending necrotizing

Journal Title: International Journal of Critical Illness and Injury Science
Year Published: 2020

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