Necrotizing Fasciitis of the Forearm in a 20-Week Pregnant Woman: Case Report and Literature Review

TL;DR

A 20-week pregnant woman developed a rare and severe skin infection in her forearm, requiring urgent treatment and multiple surgeries to save her life and the fetus.

Contribution

This case report adds to the limited understanding of necrotizing fasciitis during pregnancy and emphasizes the need for further research.

Findings

The patient required three surgeries and intensive care to treat the infection and preserve the fetus.

No recent trauma or contamination source was identified, highlighting the unpredictable nature of the condition.

The patient recovered with a successful graft and ongoing epithelialization of the donor area.

Abstract

Background and Clinical Significance: Necrotizing fasciitis (NF) is a rare skin and soft tissue infection that progresses rapidly to necrosis and can be life-threatening. The incidence varies by geographic region but is generally low, with a mortality rate ranging between 11 and 22%. Early diagnosis and treatment are crucial for survival, particularly in patients with underlying conditions such as immune suppression, diabetes, obesity, trauma, recent surgical procedures, or renal pathology. However, the relationship between pregnancy and NF has not been extensively studied. Case Presentation: The case presented involves a 37-year-old, 20-week pregnant woman, who presented to the emergency department with septic shock and left forearm compartment syndrome. She reported no recent trauma or obvious source of contamination. The patient was immediately admitted and taken to the operating room. During admission, she underwent three surgeries, consisting of staged debridement, fasciectomy, and vacuum therapy and skin grafting. The patient was carefully monitored in the intensive care unit and multiple obstetrical consultations were performed to monitor the fetus. The patient was discharged with a fully integrated graft and with the donor area undergoing epithelialization. Conclusions: This case highlights the importance of early diagnosis and treatment of NF, particularly in high-risk patients, and the need for further research into the relationship between pregnancy and NF.

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