Klebsiella pneumoniae necrotizing fasciitis on the upper lip in a patient with uncontrolled diabetes

Abstract

A 60-year-old woman with a history of diabetes mellitus and chronic renal failure was admitted to the hospital with severe pain in the upper lip, which began 4 days prior to admission, accompanied by a bullous lesion and suspected cellulitis in the upper lip. Immediately after admission, as the patient´s general condition worsened, tests revealed a non-ST elevated myocardial infarction, septic embolism of the lung, as well as septic shock. Her upper lip suddenly presented a gangrenous and necrotic change, which the tissue and blood culture confirmed to be a Klebsiella pneumoniae infection. After a quick response, the patient's general condition improved. Subsequently, serial debridement was performed to effectively clear away the purulent discharge. While under general anesthesia, the process confirmed full-layer necrosis of the upper lip including the orbicularis oris muscle. Almost half of the entire upper lip sustained a full-layer skin and soft tissue defect, with scar contracture. Six months later, to correct the drooling and lip sealing following the defects, a scar release and an Abbe flap coverage were performed considering both functional and aesthetic aspects. The follow-up revealed a favorable corrective result of the upper lip drooling, and the patient was satisfied from a functional perspective.

September’s 2023 Full Issue PDF

“…Necrosis of the lip looked very similar to the manifestation of such a purulent-necrotic process, which is described in the English-language literature as necrotizing fasciitis. 18,19 Necrotic tissues in case of Klebsiella pneumoniae necrotizing fasciitis on the upper lip (Kim and colleagues, 2020) looked like the necrotic surface of S. epidermidis infection of the lip in our case. 18 In their case, necrosis developed due to the bullous lesion in a patient with diabetes.…”

“…18,19 Necrotic tissues in case of Klebsiella pneumoniae necrotizing fasciitis on the upper lip (Kim and colleagues, 2020) looked like the necrotic surface of S. epidermidis infection of the lip in our case. 18 In their case, necrosis developed due to the bullous lesion in a patient with diabetes. 18 Even more important is that necrosis of the upper lip also led to a septic complication-embolus in the upper right lobe of the lungs.…”

“…18 In their case, necrosis developed due to the bullous lesion in a patient with diabetes. 18 Even more important is that necrosis of the upper lip also led to a septic complication-embolus in the upper right lobe of the lungs. 18 It is of interest that the infection condition of the lower lip in the case presented by Eltayeb and colleagues (2016) was very similar to inflammatory lip condition in the case by our team.…”

The mouth in diabetes: soft tissues

“…Cultures grew Klebsiella pneumoniae . With vigorous therapy, including antibiotics and wide surgical debridement she survived, and later underwent plastic surgery 2 …”

“…With vigorous therapy, including antibiotics and wide surgical debridement she survived, and later underwent plastic surgery. 2 Lip-prints (cheiloscopy) are, like finger-prints, unique to individuals. A group in Taiwan compared lip-prints of 100 people with diabetes and 50 people without diabetes.…”