Necrotizing fasciitis of the deep cervical fascia

Introduction:

Necrotizing fasciitis is a life-threatening infection usually affecting skin and superficial fascia. Meticulous surgical debridement is the mainstay of treatment. We describe a case of cervical necrotizing fasciitis affecting the deep cervical fascia extending to the spinal canal with pneumorachis.

Methods:

A 61-year-old female with, fever 39.8 ° C and severe throat pain. She was unable to swallow fluids and foods and own saliva. At admission, she had foetor ex ore, drooling saliva mixed with a greyish black exudate, no trismus. Blood pressure was 120/70, heart rate 115, Complete blood count showed WBC: 38 × 109/l, glu: 26.4 mmol/l. She was not treated for diabetes until this moment. Computed tomography of the neck found gas collections in the retropharyngeal and lateropharyngeal space. As well as at the back of the neck, in the spinal canal from the level of the axis of C2 to the 2nd thoracic, and also in the subclavicular are and around the apices of lungs.

Results:

the retroparyngeal space was drained transorally. Necrotic tissue was found and no pus. The lateral space was drained externally. Wound culturing revealed Streptococcus pyogenes known to cause necrotizing fasciitis. Inflammatory markers started to drop, but the patient suffered acute circulatory failure and cortical damage 48 hours of admission. She passed away 4 days later with multiple organ failure.

Conclusion:

Cervical necrotizing fasciitis may affect only the deep fascia. Extent of affected tissues may be difficult to assess clinically and debridement virtually impossible. Although rare pneumorachis rarely occurs adjacent to an aggressive infection in the oral cavity and pharynx. It is a very bad prognostic mark.

Publication History

Publication Date:
18 April 2018 (online)