Skull Base 2006; 16(4): 201-205
DOI: 10.1055/s-2006-950387
CASE REPORT

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Necrotizing Fasciitis of the Skull Base and Neck in a Patient with AIDS and Non-Hodgkin's Lymphoma

Oren Cavel1 , Ziv Gil1 , Avi Khafif1 , Leonor Leider-Trejo2 , Yoram Segev3 , Ben Werner4 , Arie Pivarov1 , Dan M. Fliss1
  • 1Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • 2Institute of Pathology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • 3Institute of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • 4Clinical Immunology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Publikationsverlauf

Publikationsdatum:
01. September 2006 (online)

ABSTRACT

Necrotizing fasciitis is a rapidly progressing, life-threatening soft tissue bacterial infection found more frequently in immunocompromised subjects and rarely in the head and neck. We report a rare case of a patient with acquired immunodeficiency syndrome (AIDS) and non-Hodgkin's lymphoma (NHL) who presented with a high fever and supraorbital cellulitis 1 week after undergoing chemotherapy. He received intravenous antibiotic therapy but soon developed dyspnea and trismus with rapid extension of the cellulitis to the face, ipsilateral infratemporal fossa (ITF), and bilateral neck. An awake tracheotomy was followed by surgical exploration and drainage and debridement of the supraorbital and ITF areas, parotid gland, and bilateral neck. He received intravenous antibiotic therapy and the surgical wound was regularly debrided for 10 days. Following a gradual recovery, the patient was discharged 2 weeks later. Early antibiotic therapy, wide surgical exploration, and a secured airway are the therapeutic mainstay for necrotizing fasciitis of the skull base and neck.

REFERENCES

  • 1 Chidzonga M M. Necrotizing fasciitis of the cervical region in an AIDS patient.  J Oral Maxillofac Surg. 1996;  54 638-640
  • 2 Mohammedi I, Ceruse P, Duperret S, Vedrinne J M, Bouletreau P. Cervical necrotizing fasciitis: 10 years' experience at a single institute.  Intensive Care Med. 1999;  25 829-834
  • 3 Vaid N, Kothadiya A, Patki S, Kanhere H. Necrotising fasciitis of the neck.  Indian J Otolaryngol Head Neck Surg. 2002;  54 143-145
  • 4 Simonart T. Group A beta-haemolytic streptococcal necrotising fasciitis: early diagnosis and clinical features.  Dermatology. 2004;  208 5-9
  • 5 Brook I, Fraizer E H. Clinical and microbiological features of necrotizing fasciitis.  J Clin Microbiol. 1995;  33 2382-2387
  • 6 , [No authors listed.] 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults.  MMWR Recomm Rep. 1992;  41 1-19
  • 7 Helmy A S, Salah M A, Nawara H A, Khatab H, Khalaf H A, El-Magid N A. Life threatening cervical necrotizing fasciitis.  J R Coll Surg Edinb. 1997;  42 410-413
  • 8 Becker M, Zbaren P, Hermans R et al.. Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management.  Radiology. 1997;  202 471-476
  • 9 Parveen K R, Sanjay C P, Yash P K. Necrotizing fasciitis of abdominal wall in AIDS.  Dig Dis Sci. 2001;  46 1139-1141
  • 10 Chidzonga M M. Necrotizing fasciitis of the cervical region in an AIDS patient: report of a case.  J Oral Maxillofac Surg. 2005;  63 855-859
  • 11 Kasper D L, Braunwald E, Fauci A S, Hauser S L, Longo D L, Jameson J L. Harrison's principles of internal medicine. New York, NY; McGraw Hill 2004: 1104-1108

Ziv GilM.D. Ph.D 

Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center

6 Weizmann St., Tel-Aviv 64239, Israel

eMail: ziv@dot.co.il