Descending necrotizing mediastinitis of tuberculosis resulting from tuberculous retropharyngeal abscess

Tuberculosis is one of the rare causes of descending necrotizing mediastinitis. We report a case of descending necrotizing mediastinitis resulting from tuberculous retropharyngeal abscess.A 70-year-old female who was previously diagnosed with military tuberculosis with polymyositis visited our hospital. She presented with dysphagia and was diagnosed with a retropharyngeal abscess. She started taking antituberculosis medications; however, after one month, the abscess had spread to the posterior mediastinum and was diagnosed as descending necrotizing mediastinitis. We performed surgical drainage of both cervical and mediastinal abscesses. Since tuberculosis was detected in both abscesses, we made an overall diagnosis of descending necrotizing mediastinitis of tuberculosis. After surgical drainage, we performed additional drainage of the dorsal subcutaneous abscesses. The purulent fluid was regularly extracted via thoracic drainage for 53 days until the fluid became normal. She continued to take antituberculosis medications, and was discharged 1 year later.Descending necrotizing mediastinitis of tuberculosis most likely takes a long course, which would be specific to tuberculosis.