Necrotizing Fasciitis Masquerading as Stroke: A Diagnostic Dilemma

TL;DR

A case of necrotizing fasciitis mistaken for stroke highlights the importance of early diagnosis and prompt treatment to prevent severe complications.

Contribution

This case report emphasizes the diagnostic challenges of necrotizing fasciitis and the need for increased awareness among healthcare providers.

Findings

Necrotizing fasciitis can present with stroke-like symptoms, leading to delayed diagnosis.

Prompt surgical debridement and antibiotics are critical for improving outcomes.

Missed early signs can result in sepsis, organ failure, and increased mortality.

Abstract

Necrotizing fasciitis (NF) poses a diagnostic challenge due to its rarity and similarity in presentation with other critical conditions. We report a case of a 79-year-old male who initially presented with altered mental status and stroke-like symptoms; he was ultimately diagnosed with abdominal wall NF spreading to the lower extremity. Despite a history of cecal mass perforation noted in prior imaging, the patient had been discharged from an outside emergency room on antibiotics, highlighting a missed opportunity for early intervention. Subsequent deterioration led to sepsis, organ failure, and ultimately, the detection of NF. Prompt recognition of subtle skin changes and laboratory abnormalities, along with a detailed physical examination, is essential for a timely and accurate diagnosis. Surgical debridement, coupled with broad-spectrum antibiotics, remains the cornerstone of treatment. Delays in surgical management significantly increase mortality, emphasizing the importance of prompt diagnosis and intervention. This case underscores the necessity for heightened awareness among healthcare providers to recognize NF promptly, especially when its clinical presentation overlaps with other critical conditions. Multidisciplinary collaboration and continued education are imperative to improve outcomes and prevent delays in the diagnosis and treatment of NF.

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