Necrotizing Fasciitis of the Skull Base and Neck in a Patient with AIDS and Non-Hodgkin's Lymphoma

Abstract

Necrotizing fasciitis is a rapidly progressing, life-threatening soft tissue bacterial infection found more frequently in immunocompromised subjects and rarely in the head and neck. We report a rare case of a patient with acquired immunodeficiency syndrome (AIDS) and non-Hodgkin's lymphoma (NHL) who presented with a high fever and supraorbital cellulitis 1 week after undergoing chemotherapy. He received intravenous antibiotic therapy but soon developed dyspnea and trismus with rapid extension of the cellulitis to the face, ipsilateral infratemporal fossa (ITF), and bilateral neck. An awake tracheotomy was followed by surgical exploration and drainage and debridement of the supraorbital and ITF areas, parotid gland, and bilateral neck. He received intravenous antibiotic therapy and the surgical wound was regularly debrided for 10 days. Following a gradual recovery, the patient was discharged 2 weeks later. Early antibiotic therapy, wide surgical exploration, and a secured airway are the therapeutic mainstay for necrotizing fasciitis of the skull base and neck.

Human Immunodeficiency Virus Infection Associated with Necrotizing Fasciitis: A Cohort Study of Texas Population, 2001-2010

“…We found that 57% of HIV-associated NF hospitalizations required ICU care. Use of ICU was mentioned in 4 patients described in prior case reports of HIVassociated NF [7,8,11,13]. Our findings are similar to those reported by Widjaja et al [27] and Das et al [24], showing need for ICU care in 63% and 56% of their patients, respectively.…”

“…The site of infection was described inconsistently in case reports of NF in HIV-infected patients. Two case reports indicated NF involving limbs [5,13], while cervical infection was described in 3 patients [7,10,11], and breast involvement in one [14]. While the small number of patients precludes meaningful analysis, the available data from these cases suggest involvement of uncommon body sites in patients with HIV-associated NF.…”

“…Chronic comorbidities were inconsistently described in reported cases HIV-associated NF though, when described, most affected patients had no non-HIV chronic illness [10,[12][13][14] or only a single one [7,11]. The reported chronic comorbidities included hypertension [7] and non-Hodgkin's lymphoma [11], with the later possibly a sequela of AIDS in the affected patient. Obesity was reported in 2.7% of our patients, markedly lower than in population studies of NF in the general population [2,24], possibly reflecting direct impact of HIV infection and its sequelae.…”

“…However, diabetes was reported only in about 1 in 7 HIV-associated NF hospitalizations, as compared to about 1 in 2 in the general population with NF [2]. Chronic comorbidities were inconsistently described in reported cases HIV-associated NF though, when described, most affected patients had no non-HIV chronic illness [10,[12][13][14] or only a single one [7,11]. The reported chronic comorbidities included hypertension [7] and non-Hodgkin's lymphoma [11], with the later possibly a sequela of AIDS in the affected patient.…”

“…However, occurrence of HIV as an underlying illness among NF patients has not been examined at a population level, with only few case reports of HIV-associated NF described to date [5][6][7][8][9][10][11][12][13][14]. While the risk of HIV-associated NF may exceed that of the general population, there are sparse data on the epidemiology of NF in these patients.…”