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CASE REPORT
Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) in a young healthy man
  1. Cong Ran1,
  2. Katherine Hicks1,
  3. Borislav Alexiev2,
  4. Andrew K Patel3,4,
  5. Urjeet A Patel5,6 and
  6. Akihiro J Matsuoka5,7
  1. 1 Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3 PDX ENT and Audiology Medical Group, Portland, Oregon, USA
  4. 4 Providence St. Vincent Hospital, Portland, Oregon, USA
  5. 5 Department of Otolaryngology – Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  6. 6 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cook County Hospital, Chicago, Illinois, USA
  7. 7 Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, Illinois, USA
  1. Correspondence to Dr Cong Ran, cong.ran{at}northwestern.edu

Abstract

An otherwise healthy 24-year-old man presented with 1 week of fever, facial pain and swelling. He initially sought care at an outside hospital, where he was diagnosed with folliculitis and sent home with oral antibiotics. On arrival at our institution, CT neck was ordered, which demonstrated diffuse submental phlegmon, prompting incision and drainage. After initial improvement, the patient experienced high fevers and increased swelling just 12 hours later. The decision was made to take the patient for operative exploration, and wide debridement was performed due to suspicion for necrotising fasciitis intraoperatively that was ultimately confirmed on final pathology. Final speciation of intraoperative culture demonstrated a clindamycin-resistant and methicillin-resistant strain of Staphylococcus aureus. The patient was managed with intravenous antibiotics, additional debridement and careful wound care. Delayed partial closure of wound was eventually performed once patient showed marked and persistent clinical improvement. The patient was discharged on hospital day 12 with close follow-up.

  • ear, nose and throat/otolaryngology
  • infectious diseases
  • head and neck surgery
  • oral and maxillofacial surgery
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Footnotes

  • Contributors CR is responsible for direct patient care, conception and design of the manuscript, background/literature research, facilitate and gather data, interpreting data, drafting the initial manuscript, editing and approve of final draft, submission and corresponding to related questions. KH is responsible for direct patient care, conception and design of the manuscript, facilitate and gather data, interpreting data, drafting the initial manuscript, editing and approve of final draft. BA is responsible for direct patient care, conception and design of the manuscript, facilitate and gathering of data, interpreting data, drafting the initial manuscript, editing and approve of final draft. AKP is responsible for direct patient care, conception and design of the manuscript, facilitate and gathering of data, interpreting data, drafting the initial manuscript, editing and approve of final draft. UP is responsible for direct patient care, conception and design of the manuscript, facilitate and gather data, interpreting data, drafting the initial manuscript, editing and approve of final draft. AM is responsible for direct patient care, conception and design of the manuscript, background/literature research, facilitate and gather data, interpreting data, drafting the initial manuscript, editing and approve of final draft, submission and corresponding to related questions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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