Post-tuberculous sclerosing mediastinitis: A case report

Sclerosing mediastinitis is a rare condition characterized by excessive fibrous tissue formation within the mediastinum, often secondary to chronic infections like tuberculosis. This condition can lead to severe compression of vital mediastinal structures, resulting in significant clinical complications. We reported the case of a 55-year-old woman with a history of inadequately treated pleuro-pulmonary tuberculosis. She presented with persistent dyspnea and dysphonia, and imaging revealed significant mediastinal fibrosis with compression of the superior vena cava (SVC) and thrombosis of the internal jugular vein. Histopathological analysis confirmed sclerosing mediastinitis with extensive fibrosis encasing the mediastinal structures. The patient was initiated on anticoagulation therapy with Rivaroxaban to address the thrombotic complications. Due to the severity of SVC compression, she was scheduled for surgical placement of an SVC prosthesis to restore normal blood flow and alleviate symptoms. This comprehensive approach aims to prevent further complications and improve her quality of life. This case highlights the critical need for early diagnosis and intervention in patients with post-tuberculous sclerosing mediastinitis. Comparisons with similar cases in the literature underscore the importance of a multidisciplinary approach to manage the complex clinical challenges associated with this condition. Early recognition and appropriate treatment are essential to prevent severe complications and ensure better patient outcomes. Sclerosing mediastinitis, particularly following tuberculosis, requires prompt and effective management to mitigate serious health impacts. This case emphasizes the importance of tailored therapeutic strategies, including anticoagulation and surgical intervention, to address the unique needs of affected patients.