A case of labio-facial necrotizing fasciitis complicating acne.
BACKGROUND
Facial necrotizing fasciitis is extremely rare. Most of the cases reported in literature are related to dental, sinus, tonsillar and salivary glands causes, but rarely as consequence of skin infection. We report a unique case of lower lip cellulitis, which was initially misdiagnosed as angioedema and subsequently progressed into lower lip necrotizing fasciitis.


METHODS
This is a case report of necrotizing fasciitis involving the lower lip as a consequence of infected skin acne in a 19 year old black female. The patient had been diagnosed earlier as a case of angioedema by a physician and treated accordingly. She was mildly anemic, hyponatremic and hypokalemic. Treatment was started immediately by incision, drainage and full debridement of the whole necrotic tissue. Triple antibiotic therapy was administered and daily irrigation and dressing were performed until full recovery. Complete healing occurred within a month by secondary intention.


CONCLUSIONS
This case demonstrates the misdiagnosis of a lip swelling leading to the development of labiofacial necrotizing fasciitis, a serious and life threatening condition. Lip angioedema is a common condition; however, lip fasciitis is rare. A broad differential diagnosis in case of lower lip swelling is essential to avoid inappropriate treatment delay.
Khartoum Teaching Dental Hospital, P.O box 122, Khartoum, Sudan. moly71090@gmail.com.
Amel Salah
AS
Eltayeb
Khartoum Teaching Dental Hospital, P.O box 122, Khartoum, Sudan.
Abdelnasir Gafar
AG
Ahmad
Faculty of Dentistry, The University of Medical Sciences and Technology, P.O Box 12810, Khartoum, Sudan.
Elnour Ibrahim
EI
Elbeshir
D000152:Acne Vulgaris / Q000150:complications*; D002481:Cellulitis / Q000150:complications / Q000175:diagnosis*; D003646:Debridement / Q000379:methods; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D008046:Lip; D008047:Lip Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
Angioedema; Lower lip; Necrotizing fasciitis