Necrotizing Fasciitis of the Cervicothoracic Region Secondary to Sternoclavicular Septic Arthritis: A Case Report

Necrotizing fasciitis is a rare but potentially life-threatening infection requiring early recognition and immediate surgical management to prevent significant morbidity and mortality. We present a case of cervicothoracic necrotizing fasciitis arising from sternoclavicular (SC) septic arthritis requiring multidisciplinary management. A 47-year-old male with history of poorly controlled diabetes mellitus, congestive heart failure, obesity, and tobacco use presented with progressive shoulder, neck and chest pain, dysphagia, odynophagia, and hoarseness. Laboratory evaluation demonstrated marked leukocytosis and severe hyperglycemia. Computed tomography imaging demonstrated extensive subcutaneous emphysema extending from the SC joint into the anterior chest wall, mediatsinum and retropharyngeal space. He underwent emergent surgical exploration that confirmed necrotizing infection with involvement of the sternum, clavicular head, sternocleidomastoid muscle and medial pectoralis muscle. His hospital course required serial operative debridement, wound vacuum therapy, and eventual chest wall reconstruction with a pectoralis major muscle flap. Infection control was achieved through coordinated care involving otolaryngology, cardiothoracic surgery, infectious disease, and critical care teams. This case highlights the importance of maintaining a low suspicion threshold for necrotizing infections in high-risk patients presenting with neck pain, severe examination findings, and systemic symptoms. Early imaging, prompt surgery interventtion, and multidisciplinary management are essential for survival in cervicothoracic necrotizing fasciitis.