Necrotizing fasciitis of chest and right abdominal wall caused by acute perforated appendicitis: Case report

INTRODUCTION: Necrotizing fasciitis is an uncommon infection characterized by a necrotic infection that rapidly diffuse along the fascia and progresses to systemic sepsis. The combined occurrence of necrotizing fasciitis of the chest wall and acute appendicitis is extremely unusual. CASE PRESENTATION: A 27-year-old man without any significant medical history presented to the emergency department, in the postoperative course of a laparotomy for perforated acute appendicitis, with septic shock and a large erythematous region over the right abdominal wall. Laboratory evaluation revealed leucocytosis and lactic acidosis. A new surgical exploration revealed a purulent peritonitis with necrotizing fasciitis involving the right lower abdomen, right psoas muscle and right retroperitoneum. On intensive care unit, the patient was managed with intravenous antibiotics and surgical debridement. In the following days, the patient developed extension of the necrosis to the right chest wall. A computed tomography scan of the chest showed right-sided pleural effusion with erosive aspect of the ribs. Necrotic tissues were debrided and antibiotic was changed due to wound superinfection with Acinetobacter Baumannii. DISCUSSION: Necrotizing fasciitis of chest due to acute appendicitis is extremely unusual. The optimal treatment associates appropriate antibiotics, oxygenation of infected tissue, and surgical debridement. CONCLUSION: Acute appendicitis resulting in necrotizing fasciitis of chest is rare but life-threatening. Early diagnosis and treatment is essential to reduce morbidity and mortality.