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

Necrotizing fasciitis (NF) is a serious life-threatening condition characterized by rapidly progressing tissue necrosis. It is associated with a high mortality rate, reaching up to 80% in some cases. Few cases of necrotizing fasciitis as a complication of casting have been reported, and most of these occurred in the orthopedic setting. The present article reports the case of a patient who developed necrotizing fasciitis following the placement of a cast and who was undiagnosed clinically. Due to the aggressive nature of the infection, the patient died shortly after the initial complaint and the case was presented to the forensic team for further evaluation by autopsy. Although cases of necrotizing fasciitis following cast application have been published in the literatures, no cases have been described within the forensic medicine setting. This is the first autopsy case report discussing this condition in a forensic medicine context, underscoring the novelty of this report. Our objective is to emphasize the importance of an early recognition of this devastating infection to avoid undesirable outcomes. Necrotizing fasciitis needs to be considered in patients with casts, particularly when presenting with pain out of proportion compared to the physical findings. The detailed autopsy findings along with the pathological and microbiological findings are also highlighted here to help forensic doctors and pathologists recognize this type of infection when encountered.