An atypical case of necrotizing fasciitis secondary to perforated cecal cancer

Abstract

Necrotizing fasciitis is an aggressive, life threatening soft tissue infection that requires high index of suspicion for diagnosis. Diagnosis is clinical with management including broad spectrum antibiotics and emergent operative debridement. The majority of cases are secondary to underlying medical processes, local tissue damage, abscess, or inciting procedure, with a paucity of data correlating causation with colon cancer. We describe the case of an 84-year-old man presenting with sepsis of unknown origin who was diagnosed with an atypical presentation of necrotizing fasciitis secondary to a perforated cecal malignancy. His case is unique in that a less virulent polymicrobial infection was likely involved as he initially improved with conservative management alone. He ultimately declined and expired secondary to overwhelming sepsis from his infection. This case highlights the importance of maintaining a high index of suspicion for necrotizing infection and considerations for alternative etiologies of infection including perforated malignancies.

Keywords: atypical necrotizing fasciitis; perforated colon cancer; retroperitoneal necrotizing fasciitis.

Figure 1

CT of the right hip with intravenous (IV) contrast.

Figure 2

CT of the abdomen and pelvis with contrast IV and per os (PO).