Necrotizing soft tissue infection of the scalp and face

Necrotizing soft tissue infections (NSTIs) are characterized by rapidly spreading, life-threatening infections with widespread soft tissue necrosis that most commonly infect the extremities, torso, and perineum. Although rare, NSTIs of the head and neck are particularly dangerous given the complex anatomy surrounding the region and demand early diagnosis, antibiotic administration, and surgical debridement.

We report a case of a 64-year-old male who presented with a NSTI of the scalp and face after sustaining a laceration to the posterior scalp. The patient initially presented at his local emergency department with subtle and nonspecific clinical signs and unrevealing imaging, which represented a diagnostic challenge for early intervention. Upon presentation to our facility's emergency department three days later, the patient had already started to develop severe sepsis and systemic involvement. As a result, despite intensive supportive care and surgical debridement, the patient's clinical course was complicated by multisystem organ failure and death.

Our case highlights the importance of maintaining a high clinical index of suspicion for NSTIs in patients with soft tissue infections of the head and neck, even when hallmark features are absent. Timeliness to intervention remains the single most important factor in determining survival.