[Acute cervical necrotizing fasciitis of pharyngeal origin: possible role of steroidal and non-steroidal anti-inflammatory agents. Apropos of 5 cases]

Abstract

Within 20 cases of cervical acute necrotizing fasciitis treated in the intensive care unit and hyperbaric oxygen therapy department between 1986 and 1995, the authors report five cases of pharyngeal origin. 4 have been initially treated with anti-inflammatory drugs: non steroidal (1 case), steroidal (2 cases), non steroidal and steroidal (1 case). The five patients have been operated. They needed at least 30 days of endotracheal intubation and hyperbaric oxygen therapy. No death outcome but a important morbidity is reported. The immunosuppressive features of the two type of anti inflammatory drugs are exposed. Different publications suggesting the possible association between non steroidal anti inflammatory drugs and non cervical necrotizing fasciitis are reported. It is not possible to prove a direct link because of the number of our cases, because of the wide number of pharyngitis treated in the area, and because the absence of precise data about the use of anti inflammatory drugs in the initial treatment of this pharyngitis. Existence of other type of antalgic and non immunosuppressive drugs make the use of anti inflammatory drugs not justify.