Complicated necrotizing skin and soft tissue infections and myiasis. A case report and minireview

Necrotizing fasciitis is a catastrophic condition for patients and a major challenge for clinicians. The consequences in vulnerable patients are often dramatic, with higher rates of amputation and mortality. This disease is predominantly of bacterial origin. The coexistence of necrotizing fasciitis and parasitic infections, such as myiasis, is extremely rare and poses significant diagnostic and therapeutic challenges. This report describes an unusual case of necrotizing fasciitis and myiasis in a 38-year-old diabetic patient caused by blunt trauma. The patient presented with extensive skin necrosis, systemic inflammatory response syndrome, diabetic ketoacidosis, fluid and electrolyte imbalances. The diagnosis of necrotizing fasciitis was confirmed on the basis of clinical, laboratory findings, the Laboratory Risk Indicator for Necrotizing Fasciitis score, and imaging studies. A multidisciplinary team stabilized the patient’s hypovolemic and metabolic status. Empirical antibiotic therapy was initiated and subsequently adjusted according to the antibiogram. Multiple surgical debridements were necessary. The presence of myiasis was an unexpected finding on histopathological examination. The clinical outcome was both life- and limb-saving. This case highlights uncertainties in current guidelines and raises the question of whether myiasis acted as a primary trigger or a secondary invader. It underscores the importance of comprehensive diagnostic evaluation, including histopathological and entomological assessment.