A Case of Cervical Necrotising Fasciitis Precipitated by Hypopharyngeal Squamous Cell Carcinoma

Cervical necrotising fasciitis (CNF) is a rare but life-threatening soft tissue infection of the head and neck, associated with high morbidity and mortality despite advances in disease detection and antimicrobial therapy. It most commonly arises from odontogenic or pharyngeal sources, and presentation secondary to underlying head and neck malignancy is uncommon. We report the case of a 54-year-old woman who presented with rapidly progressive anterior neck swelling, subcutaneous emphysema, and septic shock. Cross-sectional imaging demonstrated extensive gas-forming infection involving multiple cervical fascial planes with mediastinal extension. The patient underwent radical surgical debridement and thoracic washout. Intraoperative laryngoscopy revealed ulcerated mucosa in the left pyriform fossa with a suspected mucosal perforation, with biopsy confirming moderately differentiated squamous cell carcinoma (SCC). The patient stabilised with broad-spectrum antimicrobial therapy and intensive care support, but in light of the cancer diagnosis, her family decided to withdraw active management, and the patient died five days following admission. This case represents a rare presentation of CNF arising secondary to an occult oropharyngeal SCC. Tumour-associated mucosal breach and local tissue invasion likely facilitated bacterial spread into deep cervical spaces. The presence of mediastinal extension, septic shock, and underlying malignancy contributed to the poor prognosis despite timely surgical intervention. CNF may represent a first manifestation of head and neck malignancy. In the absence of an identifiable odontogenic or traumatic source, clinicians should maintain a high index of suspicion for underlying mucosal perforation. Early recognition, prompt surgical management, and multidisciplinary care are the cornerstones in the management of CNF, although outcomes remain poor in advanced disease.