A Patient with Mediastinitis Complicated by Pyrogenic Spondylitis after Coronary Artery Bypass Grafting

(Department of Cardiovascular Surgery, Nishiarai Hospital Heart Center, Tokyo, Japan)

Koji Kohno Hiroshi Amano Yasushi Kawai
Yasuo Takeuchi
A 59-year-old man with myocardial infarction underwent 4-vessel coronary artery bypass grafting. After operation, on the 9th hospital day, fever, dehiscence of the median wound, and pus discharge were observed. Methicillin-resistant Staphylococcus aureus(MRSA)was detected in the wound, and median wound curettage and removal of the sternal bone wire were performed. The infection also involved the substernal area and anterior mediastinum, and a diagnosis of mediastinitis was made. After wound cleansing and antibiotic(vancomycin)administration, inflammatory reactions decreased, and MRSA disappeared from the wound. The wound spontaneously closed, and complete closure required 60 days. On the 75th hospital day, pain from the right shoulder to the neck and numbness in the upper limbs suddenly developed. MRI revealed vertebral body destruction at C5-6, and a diagnosis of cervical osteomyelitis was made. The spinal cord was compressed, and there was a risk of spinal cord injury below the cervical spine. After consultation with orthopedic surgeons, cervical anteroposterior fixation was performed, he improved, and was discharged. We report a patient with MRSA mediastinitis complicated by cervical osteomyelitis who required emergency surgery.
  Jpn. J. Cardiovasc. Surg. 39:141-143(2010)

Keywords:coronary artery bypass grafting, mediastinitis, pyrogenic spondylitis