Secondary craniofacial necrotizing fasciitis from a distant septic emboli: A case report

Figure 1 Preoperative computed tomographic imaging. A: Axial computed tomography (CT) showing multiple soft tissue abscesses with air bubbles (white arrow); B: In the enhanced phase, axial CT showing a polymorphic wall with enhancing lesions in the muscle (white arrow).

Figure 2 Chest X ray taken at the time of admission of the patient. Multiple masses and nodules are observed as findings of septic pneumonia caused by hematogenous metastasis.

Figure 3 Computed tomographic imaging of internal organ abscesses. A: Septic emboli on chest computed tomography (white arrow); B: Large renal abscess lesions are observed on abdominopelvic computed tomography (black arrow).

Figure 4 The graph of quantitative change of high-sensitivity C-reactive protein, white blood cell and albumin in laboratory findings. Before and after percutaneous catheter drainage insertion, high-sensitivity C-reactive protein and white blood cell decreased, and albumin recovered to 3 or higher as the patient’s clinical symptoms improved. hs-CRP: High-sensitivity C-reactive protein; WBC: White blood cell; POD: Postoperative day.

Figure 5 Postoperative computed tomographic imaging. A: At postoperative day 25 showing a greater decrease in the size of abscess formation in the left masseter and temporalis muscles (white arrow); B: Abdominopelvic computed tomographic images. On postoperative day 45, The abscess is in remission and is not observed (black arrow).

Figure 6 Timeline of reported events. The chronological sequence of changes in clinical manifestation, examination and management was recorded. LRINEC: Laboratory risk indicator for necrotizing fasciitis; POD: Postoperative day; CT: Computed tomography; hs-CRP: High-sensitivity C-reactive protein; APCT: Abdominal and pelvic computed tomography; ICU: Intensive care unit; MRI: Magnetic resonance imaging; EEG: Electroencephalography; PCD: Percutaneous catheter drainage.