Necrotizing fasciitis of the neck: A rare diagnostic emergency

Abstract

A 76-year-old male, with no prior medical history, was referred to our hospital due to odynophagia and fever with 3 days, sudden worsening with dyspnea, drooling, edema and anterior neck pain. Physical examination revealed tachypnea, trismus, halitosis, bulging of the pharyngeal lateral walls and salivary stasis. No evidence of peritonsillar abscess or tonsil exudate was observed. Contrast-enhanced computed tomography (CT) of the neck revealed an organized collection involving both parapharyngeal and retropharyngeal with air bubbles and edema of the surrounding tissues (Figure 1). The patient was immediately admitted, started empiric broad-spectrum antibiotic therapy and submitted to an emergent surgical drainage. After securing the airway with tracheotomy, a trans-cervical drainage was performed. The drained pus had a grayish color and a foul smell. Necrotic tissue of fascia and sternocleidomastoid muscle were removed, as much as possible, without compromising vital structures. The cervical spaces were irrigated with a diluted solution of povidone-iodine and hydrogen peroxide. Penrose drains were placed and the skin was “loosely” approximated with minimal sutures. (Figure 2). Microbiology of the pus culture revealed the presence of Streptococcus constellatus, Eikenella corrodens, Prevotella buccae and Parvimonas micra.