Fatal craniocervical necrotizing fasciitis in an immunocompetent patient: a case report and literature review.
BACKGROUND
Craniocervical necrotizing fasciitis (CCNF) is a rapidly progressive, severe bacterial infection of the superficial fascial planes of the head and neck. Group A beta-hemolytic Streptococcus, staphylococcus aureus, and obligate anaerobic bacteria are common pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CCNF. Recently the lay press has referred to necrotizing fasciitis in several articles about "flesh eating" bacteria, which have resulted in several deaths.


METHODS
We report the first case of a fatality in an otherwise immunocompetent patient. The patient was a 66-year-old black man with no identifiable source of infection and no history or evidence of immunocompromising disorders.


RESULTS
Despite aggressive surgical debridement and broad-spectrum antibiotic coverage, he died 30 hours after admission from multisystem organ failure secondary to overwhelming sepsis.


CONCLUSIONS
Treatment consists of early recognition of CCNF combined with aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broad-spectrum intravenous antibiotic coverage. Although 11 other fatal cases of CCNF have been previously reported, all had an underlying medical problem which created an immunocompromised state, usually diabetes mellitus or chronic alcoholism. We present a case report and literature review along with a discussion of the related anatomy.
Henrich
D E
DE
Division of Otolaryngology/Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7070, USA.
Smith
T L
TL
Shockley
W W
WW
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D005208:Fasciitis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017809:Fatal Outcome; D006257:Head; D006801:Humans; D007121:Immunocompetence; D008297:Male; D009333:Neck; D009336:Necrosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D018805:Sepsis / Q000209:etiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents