Posterior mediastinal abscess in a hemodialysis patient - A rare but life-threatening complication of Staphylococcus bacteremia

Mediastinal abscess is a rare but life-threatening disease with grave prognosis if not recognized in time. The diagnosis of this entity is hampered by its nonspecific presentation. Thus, a high index of clinical suspicion is one of the keystones in the successful management of these patients. Currently, mediastinitis occurred mostly as a complication post cardiovascular or thoracic surgical procedures. Rarely, primary mediastinitis developed as a result of hematogenous spread. We report the case of primary mediastinitis in a renal failure patient who had Staphylococcus aureus bacteremia. Despite antibiotic treatment, she had massive hemoptysis and eventually succumbed to the disease. To our knowledge, this is the first report of Staphylococcus aureus bacteremia complicating mediastinal abscess in a dialysis patient with a native arteriovenous shunt. Our experience in this case suggests that dialysis patients are under constant risk of staphylococcal infection due to regular venous puncture. Measures should be taken to reduce the risk and staphylococcal infection should not be forgotten in any dialysis patient with fever of unknown origin.