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CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 4  |  Page : 220-223

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


1 Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA
2 East Carolina University Brody School of Medicine, Greenville, NC, USA, India
3 Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC; Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA

Correspondence Address:
Dr. Ian Staten
Department of Emergency Medicine, East Carolina University Brody School of Medicine. 600 Moye Blvd., Mailstop 625. Greenville, NC 27834
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCIIS.IJCIIS_75_20

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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. 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.


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