Culture Negative Necrotizing Fasciitis in the Setting of Chronic Lymphedema: A Case Report

Abstract

This case report presents findings from a unique culture-negative but biopsy-proven necrotizing fasciitis affecting the upper extremity that was successfully treated with early operative debridement. The abrupt onset of necrotizing fasciitis with an often heterogeneous presentation of physical exam and laboratory findings makes diagnosing this entity challenging. The strengths of this case report include (1) demonstrating how microorganism gram stain and culture can be negative despite suggestive findings in the operating room and (2) identifying the role of lymphedema as a contributing factor for developing necrotizing fasciitis in the absence of trauma or wounds. To the authors’ knowledge, this is the first reported case of upper extremity necrotizing fasciitis likely stemming from a patient’s chronic lymphedema after undergoing ipsilateral mastectomy and lymph node dissection for breast cancer.