Fatal facial necrotizing fasciitis: a case report highlighting diagnostic and therapeutic challenges.

Background: Facial Necrotizing Fasciitis (FNF) is a rare but aggressive, life-threatening infection involving the face's subcutaneous tissues and underlying musculature. It can rapidly progress to septic shock and multi-organ failure if not promptly recognized and treated. The clinical course, including severe pain, disproportionate tenderness, and systemic signs, is often the most crucial factor in diagnosis. While computed tomography (CT) can aid in identifying early signs such as soft tissue swelling and gas formation, clinical suspicion remains paramount and should not be delayed by reliance on imaging alone. Without early intervention, FNF may lead to devastating outcomes, including disfigurement, blindness, or death.

Case presentation: We present the case of a 70-year-old male who developed facial necrotizing fasciitis with rapid systemic progression. He initially presented to the emergency department with acute tenderness and swelling of the right ear. CT imaging revealed extensive edema and swelling in the subcutaneous fat of the face, scalp, and neck, most prominently involving the right external ear. Despite aggressive supportive measures-including ventilatory, cardiovascular, and renal support-the infection progressed to severe multi-organ failure, ultimately resulting in death.

Conclusion: This case highlights the fulminant course and high mortality risk associated with FNF. Early recognition based on clinical evaluation, supported-but not replaced-by imaging, is essential for diagnosis. Prompt intervention with broad-spectrum antibiotics and surgical debridement offers the best chance to improve outcomes and prevent catastrophic complications such as septic shock, multi-organ failure, and death.