• Feng Zhao, Leqing Lin, Hui Wang, Lei Wang, Yuxuan Xu, and Liang Guo.
• Department of Intensive Care Unit, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
• Medicine (Baltimore). 2024 Jul 5; 103 (27): e38798e38798.

RationaleDescending necrotizing mediastinitis (DNM) is a rare but serious complication of oral and cervical infections that is associated with high mortality because diagnosis can be difficult or delayed. Early diagnosis and accurate identification of the causative pathogen can significantly reduce mortality, and are critical for the management of these patients.Patient ConcernsA 56-year-old female was admitted with a sore throat and fever. The initial diagnosis was acute tonsillitis, but she was transferred to the intensive care unit after developing dyspnea.DiagnosesPleural effusion and mediastinal lesions were detected by computed tomography, and a diagnosis of DNM was confirmed by laboratory tests.InterventionsInitial treatment consisting of ceftriaxone and vancomycin with chest tube drainage were not effective. Thoracic surgery was performed to completely remove the "moss" tissue, blood clots, and pus. Next-generation sequencing was then performed, and the anti-infective treatment was changed to imipenem and linezolid based on these results.OutcomesEventually, the patient's symptoms were controlled, all vital signs were stable, and she was successfully transferred out of the intensive care unit.LessonsNext-generation sequencing is a rapid and accurate method for identification of pathogens that can provide a basis for early treatment of DNM, thereby improving patient prognosis and reducing mortality.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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