Necrotizing Fasciitis Caused by Gas-producing Methicillin-sensitive Staphylococcus aureus: A Case Report

Area of Science:

• Infectious Diseases
• Diabetology
• Surgical Pathology

Background:

• Diabetic patients exhibit impaired wound healing and increased infection susceptibility.
• Necrotizing fasciitis (NF) is a severe soft-tissue infection involving necrosis of subcutaneous tissue and fascia.
• Gas-producing infections are typically polymicrobial, making monomicrobial NF rare.

Observation:

• A 46-year-old male with undiagnosed type 2 diabetes mellitus (T2DM), diabetic ketoacidosis, and bacteremia developed gas-forming NF and abscesses.
• The patient presented with slow-onset symptoms including knee pain, erythema, and edema, progressing over days.
• Treatment required multidisciplinary care, including surgical intervention and intravenous antibiotics.

Findings:

• This case highlights methicillin-sensitive S. aureus (MSSA) as the sole causative agent of gas-forming NF.
• The patient's recovery was complicated by decreased compliance and challenges in shared decision-making.
• Monomicrobial NF caused by MSSA, especially with gas formation, remains underrecognized.

Implications:

• Physicians should maintain a high index of suspicion for NF caused by MSSA in patients with necrotizing soft-tissue infection symptoms.
• Consideration of T2DM and recent needle puncture history is important for diagnosis.
• Optimizing health outcomes necessitates effective shared decision-making in managing severe infections.