SHM Converge Scientific Abstract ePoster Gallery-Influenza's Hidden Aftermath: A Case of Mediastinal Abscess

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This case describes a 23-year-old man with recent influenza B who presented with pleuritic chest pain and tachycardia. Imaging initially showed pneumonia, bilateral pleural effusions, and a small pericardial effusion. Inflammatory markers were markedly elevated, and blood cultures grew methicillin-susceptible Staphylococcus aureus (MSSA), consistent with bacterial coinfection complicating influenza. He was treated with broad-spectrum antibiotics and oseltamivir, then narrowed to cefazolin after MSSA was identified.<br /><br />Despite treatment, he continued to have chest pain. Repeat CT imaging revealed a confluent, homogeneous anterior mediastinal mass concerning for a mediastinal abscess. Percutaneous biopsy confirmed MSSA. Bilateral thoracenteses showed exudative pleural effusions. He ultimately required 8 weeks of IV cefazolin for complete resolution.<br /><br />The discussion emphasizes that influenza is common and bacterial coinfection occurs frequently, with Staphylococcus aureus among the most common pathogens. Mediastinal abscess is a rare but serious complication of respiratory infections, with significant mortality risk. Management includes targeted antimicrobial therapy and, when needed, drainage or surgical intervention.<br /><br />The key clinical lesson is that persistent pleuritic chest pain in a patient with influenza and S. aureus pneumonia should prompt consideration of uncommon complications such as mediastinal abscess.

Asset Subtitle

Cole J. White

Meta Tag

Author List Bailey Slone White, Cole J. White

Category Clinical Vignettes

Concept Influenza

Concept Coinfection

Concept Mediastinal Abscess

Concept Staphylococcus aureus

Concept Intravenous Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital Internal Medicine Residency Program

Presenting Author Cole J. White

Track Adult

Keywords

influenza B

Staphylococcus aureus

MSSA

mediastinal abscess

pleuritic chest pain

pneumonia

pleural effusion

pericardial effusion

bacterial coinfection

cefazolin

Influenza

Coinfection

Mediastinal Abscess

Staphylococcus aureus

Intravenous Antibiotic Therapy