Multifocal Necrotizing Fasciitis of the Bilateral Chest Wall and Contralateral Lower Limb in a Patient With Diabetes:...

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection involving the fascia and subcutaneous tissues. Chest wall NF is rare and typically occurs following thoracic surgery or penetrating trauma. We report a 54-year-old man with type 2 diabetes mellitus who developed bilateral chest wall NF after sustaining a pectoralis major muscle injury while lifting a heavy engine part. Imaging demonstrated bilateral chest wall abscesses with mediastinal extension. During hospitalization, he also developed cellulitis of the contralateral lower limb, which subsequently progressed to NF, with imaging showing diffuse subcutaneous edema of the left lower leg. Wound cultures demonstrated polymicrobial growth, including methicillin-resistant Staphylococcus aureus. The patient required multiple surgical debridements, broad-spectrum antimicrobial therapy, strict glycemic control, and coordinated multidisciplinary care, ultimately achieving complete recovery. This case highlights the unusual occurrence of bilateral chest wall NF with mediastinal extension and the rare development of NF in the contralateral lower limb. It emphasizes the importance of early recognition, repeated surgical debridement, and comprehensive whole-body examination in diabetic patients presenting with sepsis, as additional or distant sites of infection may otherwise be overlooked.