Descending necrotising fasciitis of head and neck secondary to insect bite: report of a rare case

摘要

A 30-year-old diabetic male reported with continuous fever, dyspnoea and rapidly progressive painful swelling over left side of face, ear, neck extending to involve skin of the chest following an unspecified insect bite over left ear since 2 days. The lesion extended to involve left face, ear, submental, bilateral submandibular region and descended progressively to involve cervicofacial and anterior chest wall with erythema at the advancing front (A, B). Further systemic evaluation revealed 320 mg/dl random blood sugar, 102.6° fever, HR 106 beats/min, blood pressure 74/50 mmHg with 22 respiratory cycles/min with 92% O2saturation at atmospheric air. Further haematological evaluation demonstrated gross leukocytosis with presence of toxic granules and pencil cells in the peripheral smear indicative of sever sepsis/septic shock.