Unexpected necrotizing fasciitis in first day post laparoscopic hernia repair caused by rare species of Aeromonas; case report

Necrotizing fasciitis (NF) is a life-threatening skin and soft tissue infection with a significant mortality rate that is rapidly progressive, causing sepsis, systemic toxicity, and multi-organ failure. A female patient known to have high-grade serous ovarian cancer stage 3 C, for which she received neoadjuvant chemotherapy followed by surgery and then completed her adjuvant therapy in September 2018. She had a history of incisional hernia and underwent open repair of an incisional hernia in 2021. She had a recurrence and underwent laparoscopic incisional hernia repair with mesh in 2022. Two years later, she presented to the Emergency Department with features of adhesive small bowel obstruction and recurrence of incisional hernia, which was soft and reducible, managed conservatively, and planned for elective repair on the same admission. The patient showed a picture of septic shock and developed a skin manifestation of NF; she was taken emergently for extensive debridement. Unfortunately, she deteriorated the next day, developed multi-organ failure, became severely septic, and death was declared. Aeromonas are gram-negative bacteria widely present in aqueous environments; Aeromonas vironii is a very rare organism and has been identified as a rare causative agent for cellulitis and soft tissue infections. Most of the reported cases have been associated with risk factors such as liver cirrhosis, chronic kidney disease, immunocompromised, and hematological malignancies. Necrotizing fasciitis has an unexpected presentation and outcome. Early detection, administration of appropriate antibiotics, and extensive surgical debridement are crucial in any suspected skin and soft tissue infection.