Original contributionCervical necrotizing fasciitis with mediastinitis: a rare occurrence in the pediatric age
Introduction
Necrotizing fasciitis (NF), an uncommon and severe bacterial infection of the subcutaneous tissues, is characterized by widespread necrosis of fasciae and soft tissues, with a rapid course and a high mortality rate. Several terms such as acute streptococcal gangrene, bacterial synergistic gangrene, Meleney's synergistic gangrene, necrotizing soft tissue infections, and synergistic necrotizing cellulitis have been used to describe NF [1], [2], although this extremely variable nomenclature basically refers to variations of the same pathologic entity [3]. This inflammatory process is rarely seen in the pediatric population and its occurrence in the head and neck has been only occasionally reported in this age group [4], [5], [6], [7], [8], [9], [10], [11]. We describe a pediatric case of cervical NF complicated by mediastinitis that was successfully treated by immediate aggressive surgery and prolonged antibiotic therapy.
Section snippets
Case reports
In June 2003, a 13-year-old girl who had idiopathic dystonic syndrome since birth was admitted to the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy, for a painful, left submandibular swelling with bruising and fever lasting 2 days. One month before, the child had been seen at a peripheral hospital for care of her second inferior left molar tooth and had received a 10-day antibiotic course. Four days before admission, the patient started to refuse food because of an
Discussion
Necrotizing fasciitis is a rare and life-threatening disease that was first described by Jones [12] as a complication of germy disorder supervening on gunshot wounds during the American Civil War in the 19th century. In 1924, Meleney [13] reported 20 cases of patients affected by hemolytic Streptococcus gangrenes as a consequence of insect bites or minor trauma. At the beginning of the 1950s, Wilson [14] described 22 cases of severe infections and necrosis of superficial and subcutaneous
Conclusion
The clinician should be aware that NF of the neck, a life-threatening disease that may potentially complicate with mediastinitis, can occur also in the pediatric age. Early diagnosis based on a careful clinical examination and CT findings is crucial to offer the patient the best chance for survival and to plan the most adequate and immediate surgical treatment. Prompt aggressive surgery with debridement of soft tissues and prolonged intravenous antibiotic therapy are mandatory to obtain
References (28)
- et al.
Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival
J Pediatr Surg
(1996) - et al.
Necrotizing fasciitis of the pharynx following adenotonsillectomy
Int J Pediatr Otorhinolaryngol
(1999) - et al.
Streptococcal necrotizing fasciitis with toxic shock syndrome following cervical adenitis
Int J Pediatr Otorhinolaryngol
(2004) - et al.
Hyperbaric oxygen treatment: 10 years' experience of a Regional Infectious Disease Unit
J Infect
(1983) - et al.
Cervical necrotizing fasciitis
Otolaryngol Head Neck Surg
(1981) - et al.
Massive necrotizing infections of the neck
Head Neck Surg
(1981) - et al.
Progressive necrotizing surgical infections—a unified approach
J Trauma
(1981) - et al.
Necrotizing fasciitis of the parapharyngeal space with carotid artery occlusion and acute hemiplegia
Pediatrics
(1984) - et al.
Pediatric craniocervical necrotizing fasciitis
Ann Otol Rhinol Laryngol
(1996) - et al.
Cervical necrotizing fasciitis in an infant by Haemophilus non influenzae
Infection
(1997)
Cervical necrotizing fasciitis: 10 years' experience at a single institution
Intensive Care Med
Cervical necrotizing fasciitis caused by Serratia marcescens in a 2 year old
Pediatr Emerg Care
Hemolytic Streptococcus gangrene
Arch Surg
Cited by (9)
Cervicofacial cellulitis: The impact of non-steroidal anti-inflammatory drugs. A study of 70 cases
2015, European Annals of Otorhinolaryngology, Head and Neck DiseasesCitation Excerpt :This may be due to the absence of certain CFC risk factors such as smoking and alcohol consumption. There have, however, been several reports of extensive CFC in children, including mediastinal extension [17]. Mediastinal extension may be primary in certain particularly aggressive forms (with weakened diathesis or use of NSAIDs) or following late or deficient management.
Cervicofacial cellulitis: The impact of non-steroidal anti-inflammatory drugs. A study of 70 cases
2015, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-FacialeMultiple vascular complications due to cervical necrotizing fasciitis
2011, International Journal of Pediatric Otorhinolaryngology ExtraCraniocervical necrotising fasciitis-an interesting case with review of the literature
2010, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Suggestions in the literature of its increased prevalence may be due to increased awareness among clinicians.3 Early recognition and management is essential, as this condition can be fatal even when aggressively treated.2,9 CCNF is usually polymicrobial in nature.
Necrotizing fasciitis in children: diagnostic and therapeutic aspects
2007, Journal of Pediatric SurgeryCitation Excerpt :In accordance with previous reports, the abdominal wall was the most common site of involvement in our series [1-5,7]. Location in neck is rare but may lead to severe presentation owing to mediastinal dissemination, as encountered in 1 of our patients, in whom early surgical debridement and skin grafting were lifesaving [1-5,15]. The paucity of cutaneous findings early in the course of NF makes diagnosis difficult [1-5].
Techniques for early diagnosis and management of cervicofacial necrotising fasciitis
2010, Journal of Laryngology and Otology