Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11630-11637
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11630
Secondary craniofacial necrotizing fasciitis from a distant septic emboli: A case report
Da-Woon Lee, Si-Hyun Kwak, Hwan-Jun Choi
Da-Woon Lee, Si-Hyun Kwak, Hwan-Jun Choi, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
Hwan-Jun Choi, Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
Author contributions: Lee DW was involved in the concept and design of this manuscript; Lee DW and Kwak SH drafted the manuscript; Kwak SH and Choi HJ reviewed and revised the literature; and all authors have read and issued final approval of the version for submission.
Supported by the National Research Foundation of Korea Grant funded by the Korea Government (MSIT), No. 2021R1G1A1008337; and the Soonchunhyang University Research Fund.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hwan-Jun Choi, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Soonchunhyang University Cheonan Hospital, 31, Sooncheonhyang 6-Gil, Dongnam-gu, Cheonan-si 31151, South Korea. iprskorea@gmail.com
Received: July 22, 2022
Peer-review started: July 22, 2022
First decision: August 22, 2022
Revised: August 23, 2022
Accepted: September 22, 2022
Article in press: September 22, 2022
Published online: November 6, 2022
Abstract
BACKGROUND

Craniofacial necrotizing fasciitis (CNF) is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region. Symptoms usually progress rapidly, and early management is necessary to optimize outcomes.

CASE SUMMARY

A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas. The patient had fever for approximately 10 d before visiting the hospital, but did not report any other systemic symptoms. Computed tomography scan demonstrated an abscess with gas formation. After surgical drainage of the facial abscess, the patient’s systemic condition worsened and progressed to septic shock. Further examination revealed pulmonary and renal abscesses. Renal percutaneous catheter drainage was performed at the renal abscess site, which caused improvement of symptoms. The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.

CONCLUSION

As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection, the final diagnosis was secondary CNF with septic emboli. Aggressive surgical decompression is important for CNF management. However, if symptoms worsen despite early diagnosis and management, such as pus drainage and surgical intervention, clinicians should consider the possibility of a secondary abscess from internal organs.

Keywords: Craniofacial necrotizing fasciitis, Septic emboli, Klebsiella pneumoniae, Secondary, Case report

Core Tip: Craniofacial necrotizing fasciitis (CNF) is a severe infection that can rapidly spread and progress to life-threatening conditions; therefore, early diagnosis and appropriate management are essential. It can occur mainly due to odontogenic infection, but many other causes lead to development of symptoms. This report describes a rare case of secondary necrotizing fasciitis originating from internal organ abscesses. It should be considered that septic emboli from other internal organs can cause a secondary CNF if there is no improvement of symptoms after radical surgical management.