Pediatric cervicofacial necrotizing fasciitis: a case report and review of a 10-year national pediatric database

Abstract

Objective: To present a case of a pediatric cervicofacial necrotizing fasciitis (NF), a rapidly progressive infection, and a review of a 10-year pediatric inpatient database.

Design: Case report and review.

Setting: Pediatric intensive care unit.

Patients: A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code 728.86 (NF), was the inclusion criteria for the Kids' Inpatient Database (KID) in 1997 and 2006.

Results: A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from 1997 and 2006, the relative risk of being discharged with NF in 2006 vs 1997 was 1.4 (95% CI, 9.95-2.28). Age at diagnosis of NF was older in 2006 compared with 1997 (11.5 years vs 8.05 years; P < .001). Deaths with a diagnosis of NF increased from 1997 compared with 2006: from 3.9% to 5.4%. In 2006, the odds of death were 15.1 times higher in pediatric discharges with a diagnosis of NF compared with discharges without a diagnosis of NF (P < .001; 95% CI, 9.3-23.1).

Conclusions: Even with the advent of new treatments and antibiotics, the incidence and death rates of NF have changed little over the past 10 years. While it is still a rare diagnosis, knowledge and awareness of necrotizing fasciitis with aggressive medical and surgical treatment are still the foundation in disease survival.

Figure 1

Tense edema prior to initial debridement.

Figure 2

Erosion of the oral commissure.

Figure 3

A computed tomographic image of the neck with contrast demonstrating increased soft-tissue edema with no discrete group A β-hemolytic streptococcus collection or abscess. The arrow indicates the soft-tissue edema seen with the infection. It should be noted that no air is seen in this case, but can be seen in other cases of necrotizing fasciitis.

Figure 4

The defect following final debridement.

Figure 5

The patient following primary reconstruction.