A Fatal Outcome in a Case of Necrotizing Fasciitis

Abstract

We report the case of a 55-year-old female with a history of invasive urothelial carcinoma, hepatic and lymph node metastases, and prior radical cystectomy. The patient was admitted with a two-day history of fever, two weeks after undergoing percutaneous nephrostomy. Upon examination, she presented with hypotension, tachycardia, and abdominal pain. She was found to have severe lactic acidosis, acute renal failure, and a necrotizing soft-tissue infection confirmed via imaging. Blood cultures identified a multi-drug resistant Klebsiella pneumoniae infection, and the patient was treated with fluids, sodium bicarbonate, and meropenem. Despite aggressive management, the patient developed refractory septic shock and died within hours of admission. This case underscores the rapid progression and lethality of necrotizing fasciitis, even in the absence of overt skin changes, highlighting the critical importance of early recognition and intervention in such high-risk infections.

Keywords: fascia; klebsiella pneumoniae; multi-disciplinary teams; multi-drug resistant bacteria; necrotizing fasciitis; septic shock.

Figure 1. Necrotizing soft-tissue infection involving nearly the entire body circumference.

Figure 2. Necrotizing soft-tissue infection involving nearly the entire body circumference, with percutaneous nephrostomy trajectory.