Klebsiella pneumoniae cervical necrotizing fasciitis originating as an abscess

Area of Science:

• Infectious Diseases
• Microbiology
• Surgical Pathology

Background:

• Cervical necrotizing fasciitis is a severe, rapidly progressing infection.
• It is typically caused by polymicrobial infections, often involving Group A Streptococcus and anaerobes.
• Early recognition and aggressive management are crucial for patient survival.

Observation:

• A case report of a newly diagnosed diabetic male patient is presented.
• The patient underwent transoral drainage for a Klebsiella pneumoniae paraglottic abscess.
• Despite appropriate antibiotic therapy, the infection progressed to cervical necrotizing fasciitis with descending mediastinitis.

Findings:

• This case represents the first reported instance of cervical necrotizing fasciitis attributed to Klebsiella pneumoniae in the United States.
• The patient required extensive surgical intervention, including 12 debridements and sternotomy.
• Successful treatment and survival were achieved after 40 days of hospitalization.

Implications:

• This case underscores the potential for Klebsiella pneumoniae to cause severe, invasive infections like cervical necrotizing fasciitis.
• Physicians should consider unusual pathogens in rapidly progressing infections, especially in immunocompromised or diabetic patients.
• The findings highlight the importance of prompt surgical and medical management for necrotizing fasciitis, regardless of the causative organism.