Title : A rare presentation of spontaneous necrotizing fasciitis of the thoracic wall: A case report
Abstract:
Necrotizing fasciitis is a rare, life-threatening infection of the deep soft tissues that results in progressive destruction of the muscle fascia and overlying subcutaneous fat, causing tissue necrosis and systemic toxicity.
This case report describes a 30-year-old obese female with no significant past medical history with a four-day history of hidradenitis suppurativa, presented with a progressively worsening abscess beneath her right breast. Initial workup revealed Diabetes mellites. Despite initial management with broad-spectrum intravenous antibiotics, her condition deteriorated, necessitating urgent surgical debridement. Intraoperative findings confirmed extensive necrotizing fasciitis with polymicrobial infection, including Escherichia coli, Enterococcus faecalis, and Group B Streptococcus. The patient developed acute kidney injury and acute tubular necrosis due to severe sepsis and required multidisciplinary management involving surgeons, infectious disease specialists, nephrologists, and wound care management. The patient's condition improved through aggressive surgical intervention, comprehensive antibiotic therapy, and supportive care. She was discharged on oral antibiotics with outpatient diabetic and wound care follow-up.
The presentation of spontaneous necrotizing fasciitis of the thoracic wall in a young, obese female with a new diagnosis of diabetes mellitus exemplifies a rare clinical occurrence.
This case reinforces early clinical suspicion, prompt surgical intervention, and coordinated multidisciplinary care in managing necrotizing fasciitis, particularly in patients with no underlying risk factors. The discussion highlights diagnostic challenges, treatment strategies, and relevant literature supporting best practices for this life-threatening condition.
