Cervical Necrotizing Fasciitis in an Uncontrolled Diabetic Male Patient: A Multimodal Management Approach

TL;DR

A diabetic man with a severe neck infection was successfully treated using a combination of surgery, antibiotics, and wound care, highlighting the importance of early diagnosis and multidisciplinary treatment.

Contribution

This paper presents a successful case of idiopathic cervical necrotizing fasciitis managed through a multimodal approach, emphasizing the role of diabetes control and integrated treatment strategies.

Findings

The patient recovered fully within 21 days using a combination of surgical debridement, antibiotics, and wound therapies.

Early diagnosis and aggressive treatment minimized hospital stay and prevented mediastinal spread.

Optimal diabetes management was crucial in facilitating recovery.

Abstract

Cervical necrotizing fasciitis is a rare, life-threatening infection, often odontogenic. We report a case of idiopathic cervical necrotizing fasciitis in an uncontrolled diabetic patient, successfully managed through a multidisciplinary approach with good wound healing. A 54-year-old male with type 2 diabetes mellitus presented with a 10-day history of painful neck swelling and purulent discharge on the left side of the neck. Clinical examination revealed signs of necrotizing infection, confirmed by laboratory tests and contrast-enhanced computed tomography (CECT), which showed a large necrotic collection with gas formation extending to the supra-glottic region. Management included broad-spectrum antibiotics, insulin therapy, and urgent surgical debridement. Extensive necrosis involving the neck and laryngeal structures necessitated a second debridement on day seven, followed by negative pressure wound therapy. A split-thickness skin graft on day 14 led to complete healing, and the patient was discharged on day 21 with full recovery at the one-month follow-up. Cervical necrotizing fasciitis poses a high risk due to its proximity to vital structures and potential for mediastinal spread. Early diagnosis through imaging and clinical evaluation, along with aggressive surgical debridement and advanced wound care, is essential. This case underscores the importance of a multimodal strategy and optimal diabetes control in facilitating recovery and minimizing hospital stay. Idiopathic cervical necrotizing fasciitis, though rare, demands prompt diagnosis and intervention. An integrated approach, incorporating early imaging, repeated debridement, negative pressure therapy, and skin grafting, can significantly enhance patient outcomes. In this case, comprehensive management resulted in recovery within 21 days, shorter than the typical hospital stay for similar cases.

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