Mediastinal eosinophilic sclerosing fibroplasia associated with Staphylococcus aureus infection in a cat.

Case summary: A 7-year-old female spayed domestic shorthair cat presented with respiratory distress. Initial diagnostics revealed a large cystic mass in the mediastinum and moderate hyperglobulinaemia. Additional abnormalities were ruled out through thoracic and abdominal CT. The mass was surgically removed, and antibiotic treatment was started based on cytological findings of intralesional bacteria. Histopathology and microbiology confirmed a severe inflammatory reaction pattern compatible with feline eosinophilic sclerosing fibroplasia (FESF) associated with Staphylococcus aureus. After surgery and antibiotic therapy, clinical signs and related abnormalities fully resolved. At the time of writing, 24 months postoperatively, the patient shows no evidence of relapse.

Relevance and novel information: FESF, initially described as an inflammatory condition affecting the gastrointestinal tract, has also been anecdotally reported in other locations, including the retroperitoneum, retropharyngeal region and mediastinum. This report is the second to document a mediastinal presentation without concurrent abdominal involvement, and the first to achieve long-term remission without the use of immunosuppressants. It supports the hypothesis that FESF may represent a characteristic pattern of inflammation secondary to a range of triggers rather than a distinct disease process, indicating that treatment should probably target the specific underlying cause.