A case of cervical necrotizing soft tissue infection

We treated a 62-year-old woman with a cervical necrotizing soft tissue infection of the Streptococcus milleri group. Numerous spot gas images were recognized from the right pharynx to the neck in CT at initial diagnosis, but we chose conservative treatment because abscess findings were not clear. The inflammation improved temporarily, but we operated through an outside incision because symptoms recurred and cervical skin became necrotic after one week. Inside, the fascia were necrotic and an abscess extended from the precordia to the left upper arm and the right axillary region. The cervical skin defect was restored in due course in about 2 months and cured without mediastinitis or sepsis developing. The S. milleri group was detected in pus. A cervical necrotizing soft tissue infection does not form an abscess mainly in one space as does a normal deep neck infection and invades fascia space rapidly and widely. We took this disease into consideration and had to intervene surgical rather soon. A review of this case and the literature indicates that the S. milleri group may have become an important pathogen in cervical necrotizing soft tissue infection.