Necrotizing fasciitis (NF) is a severe, rapidly progressive bacterial infection of soft tissues, characterized by destruction of fascia and subcutaneous tissue and high mortality risk. Its presentation can be insidious, delaying diagnosis and compromising prognosis. Diabetic patients have increased risk due to relative immunosuppression and microangiopathy. A 47-year-old male with poorly controlled type 2 diabetes presented with pain and swelling in the right foot after blunt trauma, progressing to ascending areas of tissue necrosis, subcutaneous emphysema and foul-smelling purulent discharge. Laboratory tests showed marked leukocytosis (49,100/mm³) and very high CRP (555 mg/L), suggesting severe infection. Clinical suspicion of NF was raised, empirical antibiotics with clindamycin and ceftazidime were started, and the patient was referred for emergency surgery. A guillotine transtibial amputation was performed, with intraoperative findings of extensive muscle necrosis and pus in deep planes. In the immediate postoperative period, he developed hemodynamic instability and sepsis. Tissue cultures grew Enterococcus sp. and Enterobacter sp., pathogens associated with severe polymicrobial infections, often resistant and capable of rapid progression. Antibiotic therapy was adjusted to piperacillin-tazobactam, with significant laboratory improvement (CRP decreased to 20.7 mg/L in seven days) and good clinical evolution. He was discharged after nine days, with a healing wound and established outpatient follow-up. NF is a medical emergency that requires rapid clinical diagnosis, intensive support and early surgical management. This case highlights the importance of prompt recognition in high-risk patients and coordinated action between infectious diseases and surgical teams to avert fatal outcomes. Identification of Enterobacter and Enterococcus, both capable of deep tissue invasion and exaggerated inflammatory responses, underscores the need for broad-spectrum initial antibiotic coverage and subsequent adjustment based on cultures. Early amputation was decisive for infection control and patient survival. This report reinforces the relevance of NF in the differential diagnosis of extensive skin infections in diabetic patients and the need for rapid, integrated action to prevent irreversible progression.
Vieira et al. (Sun,) studied this question.