Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review

Țenț, Paul Andrei; Juncar, Mihai; Mureşan, Ovidiu; Arghir, Oana Cristina; Iliescu, Dan; Onişor, Florin

doi:10.1177/0300060518788490

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…In addition to a clinical examination with the detection of characteristic signs and symptoms, including the presence of cutaneous emphysema, the diagnosis of periocular necrotizing fasciitis requires imaging examination, such as an MRI, to confirm or support the diagnosis [2,3,36,37]. Surgical treatment is always necessary and must be combined with antibiotic treatment tailored to the sensitivity of the germs involved in the etiology of the disease.…”

Section: Discussionmentioning

confidence: 99%

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

Pertea,

Fotea,

Luca

et al. 2023

JPM

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(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient’s survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities.

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Section: Discussionmentioning

confidence: 99%

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

Pertea,

Fotea,

Luca

et al. 2023

JPM

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“…Additionally, there were some unusual causes of HNnf including an infected occipital psoriatic plaque and bathing in a public hot tub. 15,16 Some patients developed HNnf following lacerations from a rusty nail, razor blade, or glass window. [17][18][19] One patient even developed HNnf as a result of buccal mucosa injury with a toothbrush, illustrating the potential to develop HNnf from trivial injury.…”

Section: Comorbidities and Infection Sourcementioning

confidence: 99%

Head and Neck Manifestations of Necrotizing Fasciitis: A Case Series and Meta-Analysis

Yan

Holan

Padilla

et al. 2023

FACE

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Introduction: Plastic surgeons frequently take facial trauma calls, and their responsibilities may include infection care. The head and neck is a site of presentation for necrotizing fasciitis which requires a high level of suspicion and prompt acti2on for diagnosis and treatment. We performed a meta-analysis of the literature on necrotizing fasciitis of the head and neck (HNnf) to summarize clinical factors, causative organisms, and treatment, and included 2 cases presenting to our institution. Methods: A meta-analysis of the literature from 1990 to 2021 was completed on HNnf. After institutional review board approval, medical records of 2 patients presenting with a diagnosis of HNnf to an academic plastic surgery center between July and September 2021 were retrospectively reviewed. Systematic reviews and articles without comprehensive individualized patient data were excluded. Results: A systematic review was performed including 2 cases presenting to our institution. A total of 149 individual cases of HNnf spanning a 30-year period were included. The most common associated comorbidity was diabetes mellitus. The most frequent source of infection was odontogenic. Most patients required serial debridements in addition to IV antibiotics. Streptococcus pyogenes was the most frequent pathogen; however, most infections were polymicrobial. Infections in the periorbital region were significantly monomicrobial ( P = .011). Acute reconstructive surgery requirements: 27 patients had skin grafting, 9 had flap reconstruction. Mortality rate was 12.3%. Increasing age was a significant predictor of mortality ( P = .01). Patients with diabetes were significantly more likely to die from HNnf (52.6%, P = .039) and require multiple debridements ( P = .001) for HNnf as compared to patients without diabetes. Infections initially arising from the submandibular region were found to be an independent negative predictor of mortality ( P = .029). Conclusion: Our experience with HNnf along with meta-analysis of the literature revealed trends in demographics, presentation, organisms, and outcomes, increasing the collective knowledge of this rare entity.

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Necrotizing fasciitis of the neck with pharyngeal fistula: An unusual case presentation

Khan

Zhu

et al. 2020

International Journal of Infectious Diseases

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A 16-year-old male presented with 20 days history of intermittent fever, and asphyxia for 6 days. On physical examination, his temperature was 38.5 C, neck was soft, the trachea was centered, and chest expansion was symmetrical. However, decreased breath sounds on the right side were noted.After admission, white blood cell count was 20.71 Â 10 9 /L, bacterial cultures of sputum, neck, peritoneal drainage, and hydrothorax demonstrated viridans streptococcus, acinetobacter baumannii, methicillin-sensitive staphylococcus aureus, and aeromonas hydrophila with staphylococcus epidermidis. Thyroid ultrasonography showed thyroid abscess, diffuse lesions in the left lobe, and hypoechoic mass for which ultrasound-guided drainage was performed. Initial computed tomography (CT) revealed subcutaneous emphysema involving left parapharyngeal and retropharyngeal spaces, neck, upperchest, mediastinum, right lower lung consolidation and right pleural effusion (Figure 1A-B). Gastroscopy, laryngoscope, and bronchoscopy showed posterior pharyngeal wall fistula without tracheal esophageal fistula (Figure 1-C).Gastrostomy for enteral nutrition, surgical debridement of the neck, and placement of drainage tubes were performed under general anesthesia.After comprehensive treatment with antibiotics including sulperazone, imipenem-cilastatin, vancomycin, and tigecycline in the Intensive Care Unit, the CT scan of the abdomen, chest, and neck showed slight improvement. Subsequently, thorough improvement was recorded in the final CT scan (Figure 1-D). A followup of various laboratory tests showed no obvious abnormalities. The patient recovered well without complications.This form of infectious disease involves the skin, subcutaneous tissue, fascia, causing systemic toxicity, and even death if not recognized early and managed promptly (Tent et al., 2018).

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Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review

Cited by 3 publications

References 38 publications

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

Head and Neck Manifestations of Necrotizing Fasciitis: A Case Series and Meta-Analysis

Necrotizing fasciitis of the neck with pharyngeal fistula: An unusual case presentation

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