A Case of Subacute Necrotizing Fasciitis due to Serratia marcescens

Necrotizing fasciitis (NF) is a progressive inflammatory infection of the fascia that is often aggressive and advances insidiously. NF can be preceded by traumatic injury or surgical intervention or may occur spontaneously. Here, we describe a patient who presented with monomicrobial subacute necrotizing fasciitis due to Serratia marcescens. Dermatology was consulted at the local hospital for suspected cellulitis with no resolution using appropriate antibiotics. Our patient failed to show improvement with antibiotic treatment and experienced an above-the-knee amputation. We have also included a review of the current literature on subacute necrotizing fasciitis and S. marcescens. A case review of 25 patients resulted in rates of 52.1% for overall mortality, 72% for mortality among patients treated with only antibiotics, and 40% for mortality among patients treated with surgical debridement. There needs to be a high suspicion for necrotizing fasciitis even in patients presenting with cellulitis without systemic symptoms. If S. marcescens is isolated, more aggressive treatment may be warranted. More cases of subacute necrotizing fasciitis and S. marcescens need to be reported in the literature to better understand early diagnosis and best management practices.