Necrotizing Fasciitis After Cesarean Section: A Case Report

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection requiring prompt diagnosis and aggressive surgical intervention. Although approximately 20% of NF cases arise from postoperative infections, its occurrence after cesarean delivery is extremely rare, with an estimated incidence of 0.18%. We report a case of a 35-year-old primigravida with no significant medical history who underwent emergency cesarean section for non-reassuring fetal status. On postoperative day (POD) 6, she developed fever, elevated inflammatory markers, and uterine tenderness consistent with intrauterine infection. Subsequently, erythema and induration developed at the surgical site, and despite antibiotic therapy, her condition progressed to blistering and skin necrosis. Imaging revealed gas formation and fluid collection at the incision site. Emergency surgical debridement confirmed NF involving tissues from the epidermis to the rectus fascia. Methicillin-resistant Staphylococcus aureus was isolated from wound cultures, and intravenous meropenem and vancomycin were administered. Hyperbaric oxygen therapy and negative-pressure wound therapy were applied sequentially, followed by delayed wound closure. The patient recovered well and was discharged on POD51. Although rare in obstetric practice, NF should be considered when cesarean wound infections fail to respond to standard therapy.