Necrotizing fasciitis secondary to Wohlfahrtiimonas chitiniclastica in the absence of myiasis.

Abstract

Wohlfahrtiimonas chitiniclastica is a rare Gram-negative bacillus associated with fly larvae, myiasis, chronic wounds, and severe polymicrobial infection. We report a 71-year-old woman with diabetes, peripheral neuropathy, severe peripheral vascular disease, and previous contralateral above-knee amputation who presented with septic shock secondary to an infected right hallux ulcer. Radiographs demonstrated soft-tissue gas extending into the distal calf. Emergency exploration revealed extensive necrosis and dishwater pus tracking proximally along the flexor hallucis longus tendon, consistent with necrotizing fasciitis. Radical debridement was performed, although major amputation was initially declined. Tissue and pus cultures grew W. chitiniclastica and Enterococcus faecalis; no larvae were identified. Despite temporary clinical stabilization with intensive care support and broad-spectrum antibiotics, the foot remained non-viable and definitive above-knee amputation was required. The patient improved rapidly following source control and was discharged to rehabilitation. This case highlights the importance of early recognition, aggressive debridement, and definitive source control for survival.