Cervical necrotizing fasciitis with mediastinitis: a rare occurrence in the pediatric age

Necrotizing fasciitis (NF) is a life-threatening, progressive, bacterial soft tissue infection characterized by necrosis of skin, subcutaneous tissues, fasciae, and muscles. It usually occurs in adults and is most often localized to the abdominal wall, the extremities, the perineum, the pelvis, and the thoracic region. Localization to the head and neck area is rarely encountered, especially in pediatric patients. Early diagnosis and prompt, aggressive surgical treatment associated with intravenous, broad-spectrum antibiotic therapy are mandatory to successfully control the disease. To date, only anecdotal cases of cervical NF in the pediatric age have been described. We report a case of cervical NF with mediastinitis in a 13-year-old girl who underwent successful immediate surgery and prolonged intravenous antibiotic therapy. A literature review is also presented with particular emphasis on etiology, clinical and radiological presentation, diagnosis, and treatment of this rare disorder. (C) 2007 Elsevier Inc. All rights reserved.