Necrotizing fasciitis of the jaw, neck and mediastinum caused by Klebsiella oxytoca and Streptococcus constellatus: a case report

Abstract

Necrotizing fasciitis (NF) is a rare, fulminant, lethal soft-tissue infection result in fascial necrosis, it is rarer in the head and neck area. Infection caused by Klebsiella oxytoca is much less common. Therefore, we reported a case of NF in the maxillofacial region, neck and upper mediastinum caused by Klebsiella oxytoca as the main cause recently treated in our department. The patient is a middle-aged male with a 10-year history of diabetes with unstable insulin control. The main symptoms were pain on left side with dysphagia and fever and the situation was getting worse. The patient had limited ability to have mouth open and had hyperemia, swelling on the left pharynx, maxillofacial area, and upper left neck and skin tenderness, and all symptoms were getting worse quick. The CT mainly found out that left oropharyngeal wall, parotid gland area, bilateral submaxilla, left neck, and superior mediastinum are swelling with gas. The blood test result: leukocytes count 16.64×10 9 /L, neutrophils percentage 85.8%; C-Pr 320 mg/L; urinary routine: urine glucose (+++++), ketone bodies (+++++); fasting glucose metabolism: glucose 21.33 mmol/L, glycosylated albumin 47.67%. Three incisions of facial and neck were performed to drain pus. Result of bacteria culture: Klebsiella oxytoca and Streptococcus constellatus During treatment of DKA and reduce patient glucose level, we also treated patient with neck and trachea incisions to drain pus and cleaned daily wound area and used different antibiotics according to the bacteria culture and CT results. And finally, the patient was cured and discharged from hospital. This case of NF was very rare not only the bacteria in this case but also the pathological changes related. (involving the mediastinum). The report of his diagnosis and treatment can provide experience for future treatments.

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

“…Microbial agents present in such pathologies are diverse, including Group A betahemolytic streptococci, MRSA (Methicillin-resistant Staphylococcus aureus), Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus epidermidis, Streptococcus milleri group, Acinetobacter sp., Enterobacter cloacae, and fungi. In the reported case, Acinetobacter cloacae was implicated, and, during hospitalization under antibiotic treatment, the patient developed a secondary infection with Clostridium difficile, leading to a transfer to an infectious disease unit [12,[25][26][27][28][29][30][31]. This led to the discontinuation of surgical treatment, exacerbating the immunosuppressive state and pre-existing imbalances [24,[32][33][34][35].…”

“…Left untreated, NF can rapidly progress to septic shock and result in fatalities. Therefore, upon suspicion of NF, immediate management should include resuscitation tailored to the patient's individual needs, administration of broad-spectrum intravenous antibiotics, and early surgical intervention [6,[11][12][13][14].…”

Giant Ulcer with Necrosis on Right Vulva, Groin, and Thigh-- A Case of Necrotizing Fasciitis Associated with Erythematous Pemphigus

“…Necrotizing fasciitis is a rare, severe, and rapidly progressing disease, 3 with an incidence rate of 0.004% to 0.001%, but the global incidence is increasing. 4 Necrotizing fasciitis can occur as a complication of any trauma or injury such as surgical wounds, blunt trauma, puncture wounds, burns, lacerations, and insect bites. Patients often have comorbidities such as diabetes, smoking/alcohol abuse, liver cirrhosis, HIV infection, malignancies, long-term glucocorticoid therapy, and chronic renal failure.…”

Descending necrotizing mediastinitis caused by Streptococcus constellatus: A case report and review of the literature

“…[6][7][8][9][10][11] We complied 6 cases of DNM caused by S constellatus, and this was the second case of such severe, rapidly progressing septic shock (Table 1). [11][12][13][14][15][16] In another case, which was also very aggressive, a patient developed necrotizing fasciitis in the maxillofacial region, neck, and upper mediastinum after experiencing cold and fatigue, followed by rapid decompensation with resulting septic shock caused by S constellatus and Klebsiella oxytoca. As we can see, the patients' age ranged from 6 to 77 years old and the length of stay varied from 14 to 42 days.…”