Progressive dysphagia with fever

Introduction  Necrotizing fasciitis is a serious diagnosis with often life-threatening complications and possible lethal outcome. At first contact, patients are often already in advanced stages of the disease. The present case describes an initial pharyngeal manifestation with a complicated mediastinal course as a submaximal variant.

Material  We present the case of a previously healthy 55-year-old patient who presented to our department with clinical and radiological suspicion of a neck abscess. Intraoperative findings revealed necrotizing inflammation with incipient spread to the upper mediastinum. Despite intensive wound care, the patient developed a fulminant course with further mediastinal necrosis, tracheal necrosis, and rapid multiorgan failure based on septic shock. This was followed, among other things, by multiple necrosectomies in the mediastinum and on the trachea with mediastinal vacuum wound care, ligature of the ispilateral draining veins, installation of several chest drains and 3-month invasive ventilation.

Results  A consistent surgical approach and smear-appropriate broad-spectrum anti-infective therapy ultimately restabilized the patient.

Conclusion  In the literature, the mortality rate of mediastinal necrotizing fasciitis is up to 64%. Due to the fulminant course with often unclear outcome and the required surgical collaboration with various specialties, mediastinal forms of necrotizing fasciitis can only be treated in tertiary maximum care centers.

Publication History

Article published online:
24 May 2022