Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become widespread, but reports of complications are rare.

Case: An enlarged mediastinal lymph node (4R) was detected in a 67-year-old man 33 months after surgery for rectal cancer, and we performed EBUS-TBNA to confirm the diagnosis. He was then admitted to hospital 13 days after the procedure, with cough, a swollen mediastinal fatty area around the 4R lymph node, and elevated WBC and CRP levels. After a diagnosis of acute mediastinitis was confirmed we gave him antibiotics, which improved his symptoms, the mediastinal fatty area and his WBC and CRP levels.

Conclusion: We have to be aware of the possibility of acute mediastinitis after EBUS-TBNA of necrotic lymph nodes.

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