Necrotizing fasciitis in a plaster casted upper extremity: a forensic autopsy case report

Area of Science:

• Forensic Pathology
• Infectious Diseases
• Surgical Complications

Background:

• Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection with high mortality.
• NF as a complication of orthopedic casting is rare, with limited case reports.
• Clinical underdiagnosis of NF post-casting can lead to delayed treatment and poor prognosis.

Purpose of the Study:

• To report the first autopsy case of necrotizing fasciitis in a forensic medicine context following cast application.
• To emphasize the critical importance of early clinical recognition of NF in patients with casts.
• To highlight autopsy, pathological, and microbiological findings for forensic identification of this complication.

Main Methods:

• Case report of a patient who developed fatal necrotizing fasciitis after cast placement.
• Clinical presentation, autopsy, pathological, and microbiological investigations.
• Review of existing literature on NF following casting.

Main Results:

• The patient presented with undiagnosed necrotizing fasciitis post-casting, leading to rapid deterioration and death.
• Autopsy revealed extensive tissue necrosis consistent with aggressive infection.
• Pathological and microbiological analyses confirmed the diagnosis of necrotizing fasciitis.

Conclusions:

• Necrotizing fasciitis is a critical differential diagnosis in patients with casts presenting with severe pain disproportionate to physical findings.
• This case underscores the necessity for forensic pathologists to consider NF in post-casting deaths.
• Early identification and prompt surgical intervention are vital for improving outcomes in necrotizing fasciitis.