Mediastinitis after EUS-FNA in a Patient with Sarcoidosis - Case Report with Endosonographic Features and Review of the Literature.

[esophageal adenocarcinoma]

Background : EUS-FNA of lymph nodes is believed to harbour no risk of serious complications . However , recently , a case series of mediastinal abscess formation after EUS-FNA in patients with sarcoidosis has been published . Here , we describe a patient with sarcoidosis and mediastinitis after EUS-FNA . Case Report : Two years before EUS-FNA , the patient with a history of sarcoidosis , was operated because of esophageal adenocarcinoma . Due to progredient mediastinal lymphoma , we performed EUS-FNA to exclude tumor recurrence . 30 hours later , the patient developed general weakness , musculoskeletal pain , non-productive cough , and mild dysphagia . Ten days later , the patient was admitted with fever and thrombocytopenia . A CT scan showed a mediastinal mass without liquid areas , but small deposits of air . Meropenem , steroid , and low -dose heparin were started . The fever resolved after 24 hours , CRP , as well as coagulatory parameters returned to normal levels after 5 days . Endoscopic ultrasound revealed an inhomogeneous , slightly hyperechoic , mediastinal mass . The lymph nodes were partly dislodged , and partly embedded into this mass with a rounded shape and large hyperechoic center . Vascularization was not increased , liquid areas , or inclusions of gas were not present . A follow-up examination 6 weeks later revealed complete resolution of the mass . Conclusion : EUS-FNA , but not EBUS-FNA , seems to be associated with an increased infectious risk in patients with sarcoidosis . Endosonographic features include inhomogeneous , mass-forming mediastinal infiltration , and swelling of lymph nodes with hyperechoic central parts . In cases of suspected sarcoidosis , EBUS-FNA should be preferred . EUS-FNA , probably with antibiotic prophylaxis , should only be done after a non-diagnostic bronchoscopic work-up .

Diseases
Validation

Diseases presenting "fever" symptom

22q11.2 deletion syndrome

acute rheumatic fever

alexander disease

allergic bronchopulmonary aspergillosis

canavan disease

carcinoma of the gallbladder

child syndrome

congenital toxoplasmosis

cushing syndrome

cystinuria

dracunculiasis

erdheim-chester disease

esophageal adenocarcinoma

esophageal carcinoma

familial mediterranean fever

focal myositis

hodgkin lymphoma, classical

lamellar ichthyosis

legionellosis

locked-in syndrome

malignant atrophic papulosis

neonatal adrenoleukodystrophy

neuralgic amyotrophy

oculocutaneous albinism

papillon-lefèvre syndrome

pyomyositis

pyruvate dehydrogenase deficiency

scrub typhus

severe combined immunodeficiency

sneddon syndrome

systemic capillary leak syndrome

triple a syndrome

typhoid

waldenström macroglobulinemia

wolf-hirschhorn syndrome

This symptom has already been validated