Challenging management of craniocervical necrotizing fasciitis and descending mediastinitis in a low-resource setting: a case report and literature review

Abstract

Introduction and importance: Craniocervical necrotizing fasciitis (CCNF) is a rare and rapidly progressive infection of the fascia and subcutaneous tissue in the head and neck. Clinical presentations range from fever, neck pain, and neck swelling to severe complications, such as descending necrotizing mediastinitis (DNM). Case presentation: A 40-year-old patient from rural Ethiopia presented with a 14-day history of neck pain, swelling, and fever. Physical examinations revealed fever, tachycardia, and tachypnea. After a CT scan confirmed CCNF–DNM, the patient underwent a series of surgical interventions and was started on broad-spectrum antibiotics, which led to the improvement of the patient’s condition over the subsequent week. However, limitations in providing a robust hemodynamic support, due to a lack of blood products in the facility, led to the patient’s unfortunate death, likely secondary to severe anemia and hypovolemic shock. Clinical discussion: CCNF–DNM is a rare and severe infection of the head and neck characterized by extensive tissue necrosis and rapid progression. Management is usually aggressive, involving broad-spectrum antimicrobial coverage, rapid surgical procedures, and intensive supportive care. Even with the combined efforts of a multidisciplinary team, CCNF–DNM carries a poor prognosis with a potential for catastrophic outcomes, especially in resource-limited settings. Conclusion: This report highlights the aggressive nature of CCNF–DNM and the importance of early recognition and intervention. Even with prompt surgery and antibiotics, survival is compromised without adequate supportive resources. Increased awareness, early referral to higher-level centers, and improved access to blood products and critical care are crucial for enhancing outcomes in low-resource settings.