Necrotizing Fasciitis With Myonecrosis in a Diabetic Patient: Highlighting the Role of Early Detection and Management

Abstract

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that progresses rapidly and can lead to systemic complications. Myonecrosis, a severe complication of NF, involves muscle tissue death and often requires aggressive treatment. A 35-year-old female with diabetes mellitus, dyslipidemia, obesity, and a history of right breast cancer presented with acute, progressive right thigh pain, fever, and vomiting. Physical examination revealed local swelling, tenderness, warmth, and systemic signs of infection. Laboratory tests showed leukocytosis, elevated C-reactive protein, renal impairment, and hyponatremia. Contrast-enhanced MRI of the right thigh raised suspicion of NF with focal myonecrosis in the vastus lateralis and intermedius muscles. Surgical exploration and histopathology confirmed NF and myonecrosis. Debridement and broad-spectrum antibiotics, including vancomycin, meropenem, and clindamycin, were started. A second debridement and follow-up MRI showed improvement, with the patient recovering well and being discharged without complications. Early imaging, aggressive surgical intervention, and appropriate antibiotic therapy are critical in managing NF and myonecrosis, particularly in high-risk patients.

Keywords: diabetes; early detection; imaging; myonecrosis; necrotizing fasciitis.

Figure 1. Anteroposterior (A) and lateral (B) projections of the right femur and right knee joint show no fracture lines, preserved joint spaces, no joint effusion, and no aggressive osseous lesions

Figure 2. Two selected MRI images of the right thigh, obtained post-IV gadolinium injection in coronal (A) and axial (B) cuts, show marked edema and enhancement of the subcutaneous tissue on the anterior and lateral aspects of the right thigh

Figure 3. Multisequential and multiplanar MRI of the right thigh, obtained pre- and post-IV gadolinium administration, shows the distal portion of the vastus lateralis/intermedius demonstrating a focal area of distorted architecture (dotted arrow) with diffusion restriction (arrowhead) that lacks enhancement (arrow), representing myonecrosis. This area measures 2.4 × 2.7 × 10.6 cm in AP × TR × CC dimensions. No definite gas foci are detected. Mild edema and enhancement are noted in the biceps femoris muscle. The bilateral femurs show background heterogeneous marrow signal changes and enhancement (curved arrow), likely related to red marrow activation secondary to underlying conditions. No bone marrow-replacing lesion is present to suggest osteomyelitis