Clinical Snapshot
Cervical Necrotizing Fasciitis of Odontogenic Origin
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A 55-year-old male dialysis-dependent patient with heart failure presented as an emergency. He had a 2-week history of progressive painful swelling on the right buccal side with clinically clearly visible pharyngeal wall swelling on the right side and laboratory results showing elevated inflammatory parameters (leukocytes 19.5 × 109/L, CRP 171 mg/Ll). Computed tomography imaging revealed cervical soft tissue swelling with gas inclusions and periapical periodontitis in tooth #47. In summary, the suspicion of necrotizing fasciitis (NF) with a dentogenic focus was expressed. Intraoperatively, large areas of necrosis were observed down to the deep cervical fascia. Extensive surgical debridement was performed on several occasions, and teeth #15, #25, and #47 were extracted. In the course of postoperative intensive care, the patient’s general condition deteriorated despite intravenous antibiotic therapy with meropenem and clindamycin, and exitus letalis in septic shock followed (blood culture evidence of Peptoniphilus indolicus). From a microbiological perspective, the initial NF present in this case can be classified as type 1 with evidence of mixed aerobic/anaerobic infection (S. epidermidis, Prevotella [P. buccae, P. denticola, P. oralis], Parvimonas micra, and Dialister pneumosintes), supporting an odentogenic etiology.
Dr. med. Christopher Skusa, Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, christopher.skusa@med.uni-rostock.de
Dr. med. Romy Skusa, Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsmedizin Rostock
Dr. med. Lichun Zhang, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, „Otto Körner“, Universitätsmedizin, Rostock
Conflict of interest statement: The authors state that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Skusa C, Skusa R, Zhang L: Cervical necrotizing fasciitis of odontogenic origin. Dtsch Arztebl Int 2022; 119: 631. DOI: 10.3238/arztebl.m2022.0159
