Abstract

Background and Clinical Significance: Necrotizing fasciitis (NF) is a fulminant, life-threatening polymicrobial infection of the soft tissues, characterized by the progressive and widespread necrosis of the subcutaneous tissues and fascial planes. Although the cervical region is an infrequent site of involvement, cervical necrotizing fasciitis (CNF) is distinguished by its rapid anatomical spread, severe systemic complications, and significant mortality rates. Case Presentation: This report details the fatal clinical course of a 37-year-old immunocompetent male with no relevant active comorbidities. The patient initially presented with insidious, non-specific symptoms clinically interpreted as an uncomplicated upper respiratory tract infection/acute pharyngitis, including pharyngodynia, hoarseness, fever, lateral cervical lymphadenopathy, and catarrhal secretion. Within a brief period, his clinical status underwent rapid deterioration, with progressive cervical swelling, dysphonia, swallowing impairment, dyspnoea, shock, and subsequent multi-organ dysfunction syndrome. A total-body computed tomography scan revealed lateral cervical subcutaneous emphysema, a small pneumomediastinum, bilateral pleural effusion and bilateral pulmonary parenchymal consolidations. Conclusions: A comprehensive forensic examination revealed swelling and brownish-green discoloration of the right cervical region, palpable crepitus, and extensive necrosis of the cervical soft tissues, with involvement of the deep fascial layers and regional musculature. Histological examination confirmed massive cervical soft tissue necrosis associated with inflammatory infiltration and air bubbles. Multifocal acute pneumonia was also documented. This case underscores the importance of a meticulous examination of the cervical region during autopsy in suspected infection-related fatalities. Clinically, it highlights the diagnostic challenges posed by the deceptive and paucisymptomatic onset of CNF.

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