Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) in a young healthy man.

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.

• Authors: Cong Ran, Katherine Hicks, Borislav Alexiev, Andrew K Patel, Urjeet A Patel, Akihiro J Matsuoka
• Journal: BMJ case reports (BMJ Case Rep) Vol. 11 Issue 1 (Nov 28 2018) ISSN: 1757-790X [Electronic] England
• PMID: 30567121 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Anti-Bacterial Agents
• Clindamycin
• Methicillin

Topics

• Administration, Intravenous
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Cellulitis (diagnostic imaging, surgery)
• Clindamycin
• Debridement (methods)
• Diagnosis, Differential
• Drainage (methods)
• Facial Pain (diagnosis, etiology)
• Fasciitis, Necrotizing (diagnosis, drug therapy, microbiology, surgery)
• Humans
• Male
• Methicillin
• Methicillin-Resistant Staphylococcus aureus (isolation & purification)
• Staphylococcal Infections (diagnosis, surgery)
• Staphylococcus aureus (isolation & purification)
• Treatment Outcome
• Young Adult