Two cases of descending necrotizing mediastinitis complicating deep neck abscess

Descending necrotizing mediastinitis complicating a deep neck infection is a serious and life-threatening disease. We report two cases of mediastinitis complicating a peritonsillar abscess that were successfully treated. Case 1 was a 78-year-old woman and Case 2 was a 19-year-old woman. The patients presented with a right cervical abscess originating from a right peritonsillar abscess, and drainage of the cervical abscess was carried out immediately after admission, followed by antibiotic therapy. However, both patients eventually developed mediastinitis, and drainage of the mediastinal abscess was carried out by a thoracic surgeon in both. Subsequently, Case 1 developed septic shock and DIC. The duration of hospitalization was 126 days for case 1 and 22 days for Case 2. Based on the clinical course of our cases, we think that "unexpected neutropenia in the presence of obvious infection should be viewed as a red flag sign for the presence of a more serious condition".