A Serious Idiopathic Mediastinal Abscess Associated with Streptococcal Toxic Shock Syndrome Successfully Rescued by Surgery and Intensive Care: A Case Report

Background: Mediastinal abscesses are relatively rare; however, they have a wide range of causes. We encountered a patient with an idiopathic mediastinal abscess associated with streptococcal toxic shock syndrome due to a Group A streptococcal infection. The patient was successfully treated with two-stage surgery. Case presentation: A 66-year-old woman was diagnosed with mediastinal abscess accompanied by septic shock. Infection control was difficult, and the patient underwent incision and drainage of a mediastinal abscess. Postoperatively, the patient was treated using a combination of disseminated intravascular coagulation (DIC) therapy and polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP). Although the shock and DIC resolved, the mediastinal abscess recurred, and a second surgery was required. Blood analysis and culture revealed an idiopathic mediastinal abscess complicated by streptococcal toxic shock syndrome (STSS). One year and six months after the final surgery, the patient has been followed as an outpatient without evidence of recurrence. Conclusions: Here, we report a serious idiopathic mediastinal abscess associated with STSS that was successfully rescued with surgery and intensive care using PMX-DHP.