Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature

Abstract

Tonsillitis and peri-tonsillar abscess are common conditions which account for a large proportion of hospital admissions. They may present in a similar way to supraglottitis and retropharyngeal collection. With adequate antibiotic coverage, admissions for tonsillitis have decreased compared to cases admitting with complications. This report shows an unusual presentation of necrotising fasciitis in the neck of a 71-year-old male who presented initially with tonsillitis and later developed into supraglottitis with retroand parapharyngeal abscess complicated by necrotising fasciitis extending into pleural cavity. The patient required a prolonged stay in the Intensive Care Unit, with airway support including tracheostomy, and underwent repeated surgical drainage followed by sequential debridement (10 times). Radiological investigation and nasopharyngolaryngoscopy plays an important role in contributing to early diagnosis. Agressive debridements and necrotic tissue removal with antibiotic cover are mainstay of treatment. ARTICLE HISTORY

Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis

“…For surgery, complete debridement, such as facial-cervical fasciotomy, should be performed with removal of all involved tissue, including the pharyngeal wall, larynx, cranial nerves, and bone. Serial wound debridement is suggested to avoid the development of severe sepsis [ 34 ]. However, repeated surgery results in major soft tissue defects.…”

Streptococcus agalactiae-Induced Soft Tissue Infection in a Nonpregnant Adult After a Gynecological Procedure

“…Recent instrumentation, odontogenic infection, and penetrating injury are also important risk factors that have been implicated [ 2 , 5 ]. Though the most common sites affected by NF are the lower extremities, abdomen, and the perineum [ 4 ], involvement of other sites such as the head and neck, upper extremities, and thorax have been described [ 6 , 7 ]. The most common microbes that have been isolated are Streptococcus pyogenes , Staphylococcus aureus , and Clostridium perfringens [ 1 ], although Escherichia coli , Pseudomonas spp., Bacteroides spp., Klebsiella pneumoniae , and Streptococcus agalactiae have also been reported [ 7 ].…”