Atypical presentation of cervical necrotizing fasciitis. Case report.

Javier Moraga, Mauricio Chang, María Rodríguez

Abstract


Cervical necrotizing fasciitis (NF) is a soft tissue infection with a low incidence, characterized by rapid progression and high morbidity and mortality. The purpose of this report is to communicate the case of a patient diagnosed with cervical NF and its successful management. A 54-year-old male consulted after suffering from the condition for seven days. It was characterized by bilateral submandibular swelling, accompanied by fever, dysphagia, odynophagia, which were severely affecting the patient’s general health. Physical examination revealed a painful, erythematous cervical swelling. A cervical computed tomography scan was performed, revealing a gaseous collection in the left mucosal pharyngeal space, extending to the glottis, associated with significant deep plane soft tissue emphysema onon the left side of the neck and with possible involvement of the danger space; pertinent lab findings include 19,190/uL leukocytes and 219mg/L CRP. Broad-spectrum antibiotic therapy was initiated with ceftriaxone and clindamycin. Exploratory surgery, lavage and drainage of the collected material were performed. Streptococcus anginosus was isolated by culture. The patient recovered appropriately showing improvement in clinical as well as in inflammatory parameters, being discharged on the ninth day. He is currently receiving periodical checkups in the surgery polyclinic.

Keywords


necrotizing Fasciitis; neck; Streptococcus anginosus.

References


Giordano D, Pernice C, Pedroni C, Barbieri V. Necrotizing fasciitis of the neck: considerations about two cases. Acta Biomed. 2014;85(1):52–6.

Castillo F, Moraga J, Perez P, Alvarez C, Iglesias A. Diagnóstico y manejo precoz de la Gangrena de Fournier. Rev Chil Cir. 2015;67(2):181–4.

Sarra LD, da Silva A, Bitar J, Provítola N. [Necrotizing fasciitis of the neck]. Cir Esp. 2010;88(1):55–6.

Krenk L, Nielsen HU, Christensen ME. Necrotizing fasciitis in the head and neck region: an analysis of standard treatment effectiveness. Eur Arch Otorhinolaryngol. 2007;264(8):917–22.

Abdurrazaq TO, Ibikunle AA, Braimah RO. Cervical Necrotizing Fasciitis: A Potentially Fatal Disease with Varied Etiology. Ann Med Health Sci Res. 2016;6(4):251–6.

Daszenies C, Rahal M, Arregu R. Fascitis necrotizante de cuello. Rev Otorrinolaringol Cir Cabeza Cuello. 2004;64:247–51.

Adekanye AG, Umana AN, Offiong ME, Mgbe RB, Owughalu BC, Inyama M, Omang HM. Cervical necrotizing fasciitis: management challenges in poor resource environment. Eur Arch Otorhinolaryngol. 2016;273(9):2779–84.

Sántha B, Sári K, Fülep Z, Patyi M, Oberna F. [Necrotizing fasciitis in head and neck area]. Magy Seb. 2007;70(1):64–8.

Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. J Med Case Rep. 2013;7:223.

Gollapalli RB, Naiman AN, Merry D. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report. Ear Nose Throat J. 2015;94(7):E5–7.

Sandner A, Moritz S, Unverzagt S, Plontke SK, Metz D. Cervical Necrotizing Fasciitis--The Value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an Indicative Parameter. J Oral Maxillofac Surg. 2015;73(12):2319–33.

Gahleitner C, Hofauer B, Stark T, Knopf A. Predisposing factors and management of complications in acute tonsillitis. Acta Otolaryngol. 2016;136(9):964–8.

Elander J, Nekludov M, Larsson A, Nordlander B, Eksborg S, Hydman J. Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center. Eur Arch Otorhinolaryngol. 2016;273(12):4461–7.


Full Text: PDF

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Corresponding: Facultad de Odontología, Universidad de Concepción, Chile. Roosevelt 1550, Concepción, Chile. Phone +56-41-2204232 - Fax +56-41-2243311- Mailbox 160-C, Concepción, Chile. E-mail journal@joralres.com.