Acute Pericarditis and Mediastinal Lymph Node Abscess Developing After Endobronchial Ultrasound Guided Transbronchial Needle Aspiration
A 27-year-old man was diagnosed with inflammatory myofibroblastic tumor, and multiple lymph node and subcutaneous metastases. After several administrations of anti-tumor therapy, he underwent mediastinal lymph node biopsy using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to confirm tumor relapse. Five weeks later, he complained of chest pain, then rapidly developed shock due to acute pericarditis. Although he was treated with antibiotics for anaerobic bacterial infection and cardiac drainage, mediastinal lymph node abscess and pericarditis did not improve. After the surgical procedure, his physical condition dramatically improved and he was treated with another molecularly targeted therapy. Tumor response was obtained and has continued for 4 months. This case involved bacterial mediastinal lymph node abscess following pericarditis due to EBUS-TBNA and the patient recovered after drainage and surgical treatment. Pericarditis associated with EBUS-TBNA is extremely rare. Resident bacteria in the oral cavity may have migrated into mediastinal lymph nodes during EBUS-TBNA and then spread to the pericardium. The long period of five weeks to the onset of pericarditis and rapid progression after that onset appear attributable to slow growth of lymph node abscess caused by anaerobic bacteria that survived insufficient antibiotic treatment after EBUS-TBNA, then lymph node abscess rupture to the pericardium. In this case, salvage was achieved by surgical drainage of the lymph node abscess and pericarditis, and long survival was obtained with further administration of anti-tumor treatment.