Descending necrotizing mediastinitis as a fatal complication of NK/T-cell lymphoma: a case report

Abstract

Introduction. Extranodal NK/T-cell lymphoma (ENKL) of the nasal type is a rare and aggressive tumor with a poor prognosis. The condition often presents with atypical symptoms, leading to delays in diagnosis and treatment. This lymphoma type is haracterized by rapid progression, often involving the nasal passages, upper gastrointestinal tract, and other extranodal sites. Early detection and intervention are crucial, as the disease can lead to such severe complications as descending necrotizing mediastinitis, as observed in this case. Aim. This report describes a fatal case of descending necrotizing mediastinitis due to ENKL and highlights the clinical challenges in its management. Materials and methods. A 36-year-old male was diagnosed with ENKL after presenting with pharyngitis and aryngitis. Initial misdiagnosis and delayed histological findings prolonged the disease course over one year. Surgery, including a left-sided transcervical approach, was performed to drain the deep cervical phlegmon and mediastinum. Chest and neck CT scans were crucial in assessing disease extent and mediastinitis. Results. Despite surgery and aggressive treatment, the patient’s condition deteriorated. He developed purulent wound leakage, persistent fever, and respiratory distress, leading to fatal bleeding from the left external carotid artery on the 9th postoperative day. Discussion. ENKL has an aggressive course and poor prognosis, often being misdiagnosed due to symptom overlap with other conditions like asopharyngeal angiofibroma. In this case, delayed diagnosis and Epstein-Barr Virus (EBV) involvement contributed to rapid decline. Early biopsy and multi-specialist collaboration are essential for accurate diagnosis and treatment. Timely recognition and combined chemotherapy and radiotherapy are critical for improving outcomes. Conclusions. This case illustrates descending necrotizing mediastinitis as a fatal complication of extranodal NK/T-cell lymphoma, nasal type. The rapid, necrotic spreading into cervical and mediastinal tissues emphasizes the importance of early biopsy, accurate histological diagnosis, and timely surgical drainage. Persistent upper airway lesions require thorough evaluation to avoid delayed diagnosis and life-threatening outcomes