- i) Introduction
Necrotising fasciitis (NF) of the neck is a rare but life-threatening soft tissue infection involving superficial fat and fascia with necrosis of overlying skin. Here we discuss a case of NF caused by gas-forming monomicrobial Klebsiella pneumonia.
- ii) Case description
A middle aged, large built, Chinese male was brought into resuscitation bay with complaints of swelling over the left neck for 2 days, with hoarseness and dysphagia.
On examination, noted a 5x6cm swelling over the left sub-mandibular, extending to the midline with skin discoloration. Other physical examinations were unremarkable. His BP 170/90 mmHg, HR 120 , RR 20, temperature of 38.20C and saturating 100% on air. Chest and neck X-ray showed contralateral deviation of trachea and subcutaneous emphysema.
Intravenous Unasyn, Metronidazole and fluids were initiated. Bedside flexible scope by ENT team revealed a patent airway with medialization and edema of pharynx. In anticipation of a difficult airway, patient was electively intubated in the OT. Patient underwent neck debridement and had a tracheostomy done. Swab culture isolated klebsiella pneumonia. He was discharged well after a month.
iii) Discussion and Conclusion
Early recognition of NF is essential for treatment success. Isolation of the causative organism guides the choice of antimicrobials. Management also involves securing the airway and prompt surgical intervention.