Cervicothoracic Cellulitis Complicated by Descending Mediastinitis in a Diabetic Patient: Multidisciplinary Management and Reconstructive Surgery Using a Pedicled Pectoralis Major Muscle Flap from the Military Hospital Mohammed V, Rabat

Abstract

Introduction: Cervical cellulitis or necrotizing cervical fasciitis are soft tissue infections that develop from dental or pharyngeal sites and, if not recognized early, can spread to the mediastinum. The initial clinical signs are sometimes vague and can lead to a delay in diagnosis. The key examination is cervical and thoracic computed tomography. Treatment consists of extensive and repeated tissue excisions combined with antibiotic therapy targeting aerobic and anaerobic bacteria. We report the case of a patient with known diabetes presenting with cervico-thoracic cellulitis of cutaneous origin complicated by descending mediastinitis. highlighting the importance of early diagnosis, surgical treatment, and reconstructive surgery. Aims: We aimed to report a rare case of cervicothoracic cellulitis complicated by descending mediastinitis in a diabetic patient. Presentation of Case: We report here an observation of cervicothoracic cellulitis complicated by mediastinitis in a 66-year-old man who presented with anterior cervicothoracic swelling accompanied by oozing skin ulceration with pus discharge in the context of fever and general asthenia. Blood tests revealed an inflammatory and infectious syndrome and ketoacidosis. A cervical-thoracic CT scan confirmed the diagnosis of cervicothoracic cellulitis complicated by descending mediastinitis. An emergency cervicotomy with extensive debridement and drainage was performed. Bacteriological testing identified multisensitive Staphylococcus aureus, which led to targeted antibiotic treatment. Due to significant tissue loss, reconstructive surgery was performed. The postoperative course was that of a full recovery. Conclusion: Cervicothoracic cellulitis is a serious condition requiring urgent treatment and multidisciplinary medical and surgical care. CT imaging guides surgical planning, while surgical debridement of necrotic tissue, targeted antibiotics, and reconstruction techniques are essential for achieving favorable outcomes.