Necrotizing Fasciitis With Myonecrosis in a Diabetic Patient: Highlighting the Role of Early Detection and Management

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that progresses rapidly and can lead to systemic complications. Myonecrosis, a severe complication of NF, involves muscle tissue death and often requires aggressive treatment. A 35-year-old female with diabetes mellitus, dyslipidemia, obesity, and a history of right breast cancer presented with acute, progressive right thigh pain, fever, and vomiting. Physical examination revealed local swelling, tenderness, warmth, and systemic signs of infection. Laboratory tests showed leukocytosis, elevated C-reactive protein, renal impairment, and hyponatremia. Contrast-enhanced MRI of the right thigh raised suspicion of NF with focal myonecrosis in the vastus lateralis and intermedius muscles. Surgical exploration and histopathology confirmed NF and myonecrosis. Debridement and broad-spectrum antibiotics, including vancomycin, meropenem, and clindamycin, were started. A second debridement and follow-up MRI showed improvement, with the patient recovering well and being discharged without complications. Early imaging, aggressive surgical intervention, and appropriate antibiotic therapy are critical in managing NF and myonecrosis, particularly in high-risk patients.