Descending necrotizing mediastinitis mimicking acute ST segment elevation myocardial infarction

Descending necrotizing mediastinitis (DNM) is a rare but lethal disease. Despite prompt use of broad-spectrum antibiotics and proper surgical drainage, the mortality is still high. High vigilance for disease presentation is helpful to early diagnosis. A 59-year-old female with a history of hypertension, diabetes and dyslipidemia came to our emergency room. Her initial presentation of chest pain, elevated troponin-I level and ST segment elevation in electrocardiogram (ECG) mimicked acute ST segment elevation myocardial infarction. However, DNM was suspected by her atypical clinical presentation and imaging studies. The ST segment elevation in ECG resolved immediately after pigtail catheter drainage. Finally, DNM was proved by right thoracotomy with mediastinal exploration. Klebsiella pneumoniae was isolated from pus and necrotic tissue.