Background: Necrotizing fasciitis (NF) is rare and can be fatal unless a prompt diagnosis and aggressive multidisciplinary treatment are performed. The present case aims to show how an innocent omphalitis, treated initially with topical antibiotic cream, can evolve to a potentially life-threatening condition such as NF of the entire abdominal wall. It illustrates a surgical and antibiotic management that not only saves patients lives, but also enables the repair of the severe tissue lesions. Case Presentation: We present the case of a 44-year-old Caucasian female, diagnosed with diabetes mellitus 30 years ago that had never been treated. She came to the emergency department with a glycemia of 470 mg/dL and a 3-cm diameter peri-umbilical necrotic scar. The initial blood investigation revealed serum glucose concentration of 559 mg/dL, elevated acute phase reactants, and a metabolic acidosis. The computed tomography images were compatible with a necrotizing abdominal wall infection. A broad-spectrum antibiotic agent was prescribed empirically and urgent surgical debridement was performed. Negative pressure wound therapy (NPWT) was applied as well as several re-debridements. Polymicrobial flora grew on the wound exudate cultures so the spectrum could be changed according to the culture sensitivity of the microbial isolates and the clinical evolution of the patient. After 62 days of treatment, the wound cultures were negative and the abdominal wall could be reconstructed by means of a direct closure by abdominoplasty. In parallel, a strict glucose control was established as well as an educational intervention in order to improve long-term glycemic control. The clinical condition of the patient improved and she was discharged after 75 days of hospital stay and showed correct glycemia at outpatient visits. Conclusion: Necrotizing fasciitis of the entire anterior abdominal wall are unusual and have a poor prognosis if misdiagnosed at the initial stage as well as if indequate management and early surgical treatment are not performed. Initial broad-spectrum antibiotic agents as well as an initial aggressive surgical debridement are mandatory with further re-debridements as long as needed. Diabetes mellitus is a main predisposing factor to take into consideration.
