ST-Segment Elevation Beyond the Coronaries: A Case of Necrotizing Mediastinitis.

Authors

Swapna Sarangi, Skylar Murphy, Kyle Coombes, Ragavendar Saravanabavanandan, Shreyas Singireddy, Harshavardhan Ghadiam

Published in

JACC. Case reports. Pages 111152. Nov 02, 2026. Epub Nov 02, 2026.

Abstract

Descending necrotizing mediastinitis (DNM) is a rare, life-threatening infection (mortality 18%-36%) that can extend to the pericardium and produce electrocardiogram changes mimicking ST-segmentelevation myocardial infarction (STEMI).
A young, previously healthy man presented with anterior chest pain. Initial electrocardiogram showed ST-segment elevation prompting STEMI suspicion. Computed tomography angiography of the chest revealed deep neck infection with mediastinal and pericardial extension, diagnosing DNM. Cultures grew Streptococcus constellatus. Management included broad-spectrum intravenous antibiotics and surgical drainage/debridement with intensive care unit care; the patient recovered.
DNM arises from oropharyngeal or odontogenic infection spreading along cervical fascial planes, with mortality driven by diagnostic delay and inadequate source control. S constellatus is an uncommon cause. This case highlights pericardial involvement as a noncoronary cause of ST elevation.
Consider noncoronary causes of ST-segment elevation; early imaging is essential to diagnose DNM and guide lifesaving source control.

PMID:
42969918
Bibliographic data and abstract were imported from PubMed on 02 Nov 2026.

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