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cancer was found on follow−up examina− tions (abdominal computed tomography and positron−emission tomography scans) to have an 8−mm posterior aorto− pulmonary−window lymph node that was suspected to be malignant (l" Fig− ure 1, l" Figure 2). Radial endoscopic ul− trasound (EUS) revealed a 10−mm lymph node in the posterior aortopulmonary window (l" Figure 3). Transesophageal EUS−guided fine−needle aspiration (FNA) was performed with five passes, using a 22−gauge needle (l" Figure 4). No anti− biotic prophylaxis was given. There were no immediate complications. Cytological examination subsequently revealed this to be benign lymphoid tissue. Five days later, the patient developed chest pain, fevers, and an elevated white blood cell count. Chest computed tomog− raphy revealed inflammatory changes in the posterior mediastinal fat abutting the T5 ±T7 vertebral bodies (l" Figure 5). Four sets of blood cultures grew Gemella morbillorum. Thoracic spine magnetic resonance imaging 6 weeks after the EUS−FNA revealed diskitis and osteomye− litis at T5/6 (l" Figure 6). The patient was successfully treated with intravenous cef− triaxone for a total of 12 weeks, and then with oral amoxicillin for several months until all the symptoms and radiographic changes had resolved. This is the first reported case of trans− esophageal EUS−FNA of a posterior medi− astinal lymph node causing mediastinitis and osteomyelitis. The mediastinitis was probably caused by seeding of the target lymph node by an FNA needle contami− nated by G. morbillorum, a facultative, an− aerobic, aerotolerant, Gram−positive coc− cus which is a natural inhabitant of the human oropharynx [1]. l" Table 1 summarizes the clinical details of the seven previously reported cases of mediastinitis caused by transesophageal EUS−FNA, as well as this present case [2± Gemella morbillorum mediastinitis and osteomyelitis following transesophageal endoscopic ultrasound−guided fine−needle aspira− tion of a posterior mediastinal lymph node

endoscopy

<i>Gemella morbillorum</i> mediastinitis and osteomyelitis following transesophageal endoscopic ultrasound-guided fine-needle aspiration of a posterior mediastinal lymph node

Gemella morbillorum mediastinitis and osteomyelitis following transesophageal endoscopic ultrasound-guided fine-needle aspiration of a posterior mediastinal lymph node