Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, Seattle, WA, USA.
Am J Otolaryngol. 2012 Nov-Dec;33(6):764-6. doi: 10.1016/j.amjoto.2012.05.009. Epub 2012 Jul 16.
Cervical necrotizing fasciitis is a rapidly progressive and devastating infection that is usually caused by a polymicrobial infection including group A Streptococcus and anaerobes. We present a case of a newly diagnosed diabetic man who underwent transoral drainage of a Klebsiella pneumoniae paraglottic abscess, which, despite culture-directed antibiotics, progressed to cervical necrotizing fasciitis with descending mediastinitis. The patient required 12 surgical debridements and sternotomy, but survived and was discharged on hospital day 40. To our knowledge, this is the first case of cervical necrotizing fasciitis caused by a K pneumoniae infection in the United States. The significance of this unusual presentation is discussed.
颈坏死性筋膜炎是一种迅速进展且具有破坏性的感染，通常由包括 A 组链球菌和厌氧菌在内的多种微生物感染引起。我们报告了一例新诊断为糖尿病的男性患者，该患者接受了经口引流治疗肺炎克雷伯氏菌会厌下脓肿，但尽管进行了培养指导的抗生素治疗，仍进展为颈坏死性筋膜炎并伴有下行性纵隔炎。该患者需要进行 12 次清创和胸骨切开术，但最终存活并于住院第 40 天出院。据我们所知，这是美国首例由肺炎克雷伯氏菌感染引起的颈坏死性筋膜炎病例。本文讨论了这种不常见表现的意义。
