Asian Journal of Case Reports in Medicine and Health

Background: Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection associated with high morbidity and mortality, particularly in patients with diabetes and other comorbidities.

Case Presentation: We report a 61-year-old woman with poorly controlled type 2 diabetes mellitus, hypertension, and filariasis who presented with progressive swelling of the lower abdominal wall and left thigh, foul-smelling discharge, and ulceration. Contrast-enhanced computed tomography demonstrated extensive soft tissue edema with multiple air foci extending from the left thigh to the pubic symphysis and lower abdominal wall, consistent with necrotizing fasciitis. Laboratory findings revealed severe hyperglycemia, anemia, leukocytosis, acute kidney injury, hyperkalemia, and hypoalbuminemia. The patient underwent emergency surgical debridement under high anesthetic risk and received broad-spectrum antibiotics, intensive insulin therapy, fluid resuscitation, and multidisciplinary supportive care. Vacuum-assisted closure therapy was initiated for wound management. Over 20 days, her clinical condition, renal function, and glycemic status improved, and she was discharged stable.

Discussion: Necrotizing fasciitis carries high mortality, particularly in uncontrolled diabetes. Klebsiella oxytoca suggests an aggressive gram-negative etiology. Early diagnosis, prompt debridement, and appropriate antimicrobial therapy with strict glycemic control are critical.

Conclusion: Early diagnosis and timely surgical and medical management are essential to reduce morbidity and improve outcomes.