Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Necrotizing fasciitis is an uncommon and deadly disease entity characterized by rapidly progressing skin and soft tissue destruction. It presents on a spectrum from an initially indolent appearing sub-acute form to a hyperacute fulminant course. It may often be misdiagnosed due to the paucity of signs early in the disease course and as it can initially mimic other less serious soft tissue infections. Necrotizing soft tissue infections have both high morbidity and mortality. We present a case of a 72-year-old male patient with two anatomically and temporally separate necrotizing infections. The first necrotizing infection was diagnosed after an extended time, due to the subacute disease course in the setting of an abdominal wall infection. The second presentation was a hyperacute fulminant course in the setting of a necrotizing infection of the scrotum. In both instances, once identified, appropriate management was followed: resuscitation, broad-spectrum antibiotics, and most importantly radical surgical debridement. Extensive multidisciplinary inpatient and outpatient input was required to aid the patient's recovery. The presented case demonstrates the necrotizing soft tissue infection's spectrum of disease and the diagnostic dilemma it presents to family physicians and emergency departments alike. The only definitive management step is immediate and radical resection of the affected tissue. Extensive debridement and the resultant tissue defect require comprehensive multidisciplinary care during the extended rehabilitation and wound care treatment plan. Rapid recognition, urgent surgical debridement, and specialist care are required to reduce the mortality and morbidity associated with necrotizing soft tissue infections.