Multiorgan failure in a young patient with necrotizing fasciitis: a case report of septic shock progressing to mixed shock with fatal cardiac outcome

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Necrotizing fasciitis complicated by infective endocarditis, severe aortic regurgitation, and septic/cardiogenic shock (n=1). Intervention: Transcatheter aortic valve implantation (TAVI) with two 29-mm Edwards Sapien 3 valves alongside surgical debridement/amputation and antimicrobial therapy. Primary outcome: Clinical survival and hemodynamic stabilization.

Q: What does this research mean for the field?

Rescue transcatheter aortic valve implantation (TAVI) can temporarily stabilize hemodynamics in patients with severe infective endocarditis and cardiogenic shock, but complications such as paravalvular abscess remain a fatal risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Richard F. Kraus; Christina K. Kaufmann; Volker Alt; Martin G. Kees

doi:10.1186/s13256-026-06805-2

November 13, 2026Journal of Medical Case ReportsOpen Access

Multiorgan failure in a young patient with necrotizing fasciitis: a case report of septic shock progressing to mixed shock with fatal cardiac outcome

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Key result

Rescue TAVI temporarily stabilizes endocarditis-related cardiogenic shock, but paravalvular abscess leads to late fatal arrest.

n=1

Why the study?

Necrotizing soft tissue infections are rare, life-threatening conditions requiring immediate and aggressive treatment, and mortality remains high largely due to septic shock and severe complications despite advances in medical care.

Key Points

To describe the complex clinical course, multidisciplinary management, and fatal progression of severe necrotizing fasciitis complicated by endocarditis and multiorgan failure in a young adult.
Documented the intensive care course, surgical interventions, and diagnostic timeline of a young adult presenting with left leg necrotizing fasciitis.
Evaluated multiorgan complications including recurrent gastrointestinal bleeding, limb amputation, transcatheter aortic valve implantation (TAVI), and interdisciplinary consensus regarding venoarterial extracorporeal membrane oxygenation (VA-ECMO).
The clinical course was complicated by severe gastrointestinal bleeding, septic shock progressing to mixed shock, and infective endocarditis with a 1.5-cm paravalvular abscess caused by vancomycin-resistant Enterococcus faecium.
Despite emergency TAVI as a temporary bridge and multiple operative debridements, persistent infection, refractory heart failure, and sudden circulatory collapse led to death without initiation of VA-ECMO.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 white man in his late thirties with necrotizing fasciitis of the left leg complicated by infective endocarditis, severe aortic regurgitation, and recurrent gastrointestinal bleeding, followed for 56 days until death.

I

Intervention

Multidisciplinary critical care management including sequential surgical debridement and distal femoral amputation, prolonged targeted antimicrobial therapy (meropenem, penicillin G, clindamycin, vancomycin, ceftriaxone, fluconazole, daptomycin), endoscopic and angiographic hemostasis with adjunctive proton pump inhibitors, somatostatin, and misoprostol, and urgent valve-in-valve transcatheter aortic valve implantation (two 29-mm Edwards Sapien 3 valves) on day 46 as a bridge to definitive surgery.

O

Outcome

Clinical course and survival (the patient experienced temporary hemodynamic stabilization following TAVI, followed by complete atrioventricular block on day 53, sudden cardiac arrest with asystole, and death on day 56 due to a 1.5-cm paravalvular abscess caused by vancomycin-resistant Enterococcus faecium and prolonged sepsis).hard clinical

This case report demonstrates that while urgent TAVI can serve as a temporary hemodynamic bridge in critically ill patients with infective endocarditis and torrential aortic regurgitation when open surgery is prohibitive, persistent infection risk such as paravalvular abscess formation remains a fatal threat.

Limitations

Single-patient case report design
Lack of post-TAVI cardiac CT or transesophageal echocardiography to detect evolving peri-annular complications
Initial limb-preserving surgical strategy rather than early radical amputation
Absence of a protective loop colostomy to prevent fecal contamination of the femoral stump
Delayed radical surgical amputation (attempting limb preservation initially)
Lack of a protective loop colostomy to prevent fecal contamination of the proximal femoral amputation wound
Missed paravalvular abscess despite secondary complete atrioventricular block, which might have prompted repeat transesophageal echocardiography
Speculative benefit of combining misoprostol and proton pump inhibitors due to lack of scientific evidence in this clinical setting

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Implication

Rescue TAVI may temporarily stabilize prohibitive-risk endocarditis shock; leaves open optimal post-procedural abscess surveillance.

Abstract

Background Necrotizing soft tissue infections (NSTIs) are rare, life-threatening conditions requiring immediate and aggressive treatment. Despite advances in medical care, mortality remains high, largely due to septic shock and severe complications. Case representation We report the case of a young adult with necrotizing fasciitis (NF) of the left leg complicated by recurrent gastrointestinal bleeding and infective endocarditis, resulting in severe heart failure and ultimately leading to death. The fatal outcome was most likely attributable to prolonged sepsis with multiorgan involve- and impairment and a 1.5-cm paravalvular abscess caused by vancomycin-resistant Enterococcus faecium. Conclusion The treatment of a septic patient with progressive heart failure highlights the value of an integrative, multidisciplinary approach to complex clinical decision-making and the real-world challenges that may require patient-tailored, nonstandard therapeutic strategies. Prompt diagnosis, aggressive surgical debridement, and rigorous management of complications are essential. In cases of aortic valve regurgitation causing heart failure, TAVI implantation might serve as a temporary bridge until definitive open valve replacement becomes feasible.

Discussion

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Cite This Study

Kraus et al. (2026) conducted a case report in Necrotizing fasciitis complicated by infective endocarditis, severe aortic regurgitation, and septic/cardiogenic shock (n=1). Transcatheter aortic valve implantation (TAVI) with two 29-mm Edwards Sapien 3 valves alongside surgical debridement/amputation and antimicrobial therapy was evaluated on Clinical survival and hemodynamic stabilization. Rescue TAVI temporarily stabilized hemodynamics in a patient with endocarditis and cardiogenic shock, but a 1.5-cm VRE paravalvular abscess caused fatal arrest on day 56.

synapsesocial.com/papers/6af88c530e4d8f4b089c1b8e https://doi.org/10.1186/s13256-026-06805-2

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Multiorgan failure in a young patient with necrotizing fasciitis: a case report of septic shock progressing to mixed shock with fatal cardiac outcome

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Multiorgan failure in a young patient with necrotizing fasciitis: a case report of septic shock progressing to mixed shock with fatal cardiac outcome

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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