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Otolaryngology and Infectious Diseases / Orthopedic Infections and Treatments / Streptococcal Infections and Treatments · Journal article
Journal of Medical Case Reports · September 9, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case report describes a previously healthy adolescent with rapidly progressive necrotizing soft tissue infection presenting without classic risk factors, culture-negative sepsis, and subtle early local findings that delayed diagnosis. Early diagnostic surgical exploration ~10 hours after presentation revealed early NSTI with partial subcutaneous necrosis and viable fascia, resulting in complete recovery after prompt source control. The case illustrates diagnostic and clinical challenges in atypical NSTI and emphasizes disproportionate limb pain and serial physical examination as early warning signs, but generates clinical hypothesis rather than providing generalizable evidence.
Case report. Previously healthy adolescent male presenting to emergency department with rapidly progressive sepsis, pharyngolaryngeal symptoms, and disproportionate right lower limb pain without preceding trauma.. Intervention: Diagnostic surgical exploration revealing early necrotizing soft tissue infection, followed by emergency surgical source control and multidisciplinary antimicrobial management.. n = 1.
Previously healthy adolescent presented with rapidly progressive sepsis without trauma or classic NSTI risk factors Initial blood cultures and intraoperative subcutaneous fluid culture remained negative despite broad-spectrum antimicrobial therapy Diagnostic surgical exploration approximately 10 hours after emergency department presentation revealed early necrotizing soft tissue infection with partial subcutaneous necrosis and viable fascia
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Clinicians should maintain high index of suspicion for early NSTI in previously healthy patients presenting with disproportionate limb pain and rapidly progressive systemic toxicity, even when laboratory, microbiological, and imaging findings are non-diagnostic. Early diagnostic surgical exploration should not be delayed when clinical suspicion persists, as it enables direct tissue assessment and prompt source control.
A single case report describing an atypical presentation of necrotizing soft tissue infection without established fascial necrosis or positive cultures; provides clinical descriptors and management outcome but generates hypothesis rather than testing it rigorously.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should maintain high index of suspicion for early NSTI in previously healthy patients presenting with disproportionate limb pain and rapidly progressive systemic toxicity, even when laboratory, microbiological, and imaging findings are non-diagnostic. Early diagnostic surgical exploration should not be delayed when clinical suspicion persists, as it enables direct tissue assessment and prompt source control.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Necrotizing soft tissue infection (NSTI) is a life-threatening condition requiring early recognition and prompt surgical intervention. Although classically associated with diabetes, immunosuppression, or trauma, NSTI may also occur in previously healthy adolescents, making early diagnosis particularly challenging. Early clinical manifestations are often subtle, misleading and nonspecific, while laboratory and imaging findings may remain non-diagnostic during the early stage of disease. We report a previously healthy adolescent male presenting with rapidly progressive sepsis of unclear origin following misleading early manifestations, including pharyngolaryngeal symptoms and disproportionate right lower limb pain despite initially subtle local findings. Initial evaluation at a referring hospital demonstrated severe systemic inflammation without an identifiable infectious focus. Despite broad-spectrum antimicrobial therapy, systemic toxicity progressed with early multiorgan involvement. Serial examinations revealed evolving disproportionate limb pain and swelling, while computed tomography demonstrated deep soft tissue edema without gas or abscess. Approximately 10 h after emergency department presentation, emergent diagnostic surgical exploration demonstrated severe soft tissue infection with partial subcutaneous necrosis and viable fascia, findings most compatible with an early necrotizing soft tissue infection without established fascial necrosis. Blood cultures and intraoperative subcutaneous fluid culture remained negative following antecedent broad-spectrum antimicrobial therapy. Prompt surgical source control combined with multidisciplinary antimicrobial management resulted in complete clinical recovery. This case highlights the diagnostic challenges of a suspected early necrotizing soft tissue infection without established fascial necrosis in a previously healthy adolescent presenting with culture-negative sepsis and non-localizing investigations. Disproportionate limb pain should be recognized as an important early clinical warning sign, particularly when accompanied by rapidly progressive systemic toxicity despite initially subtle local findings. Serial comprehensive physical examination and ongoing clinical reassessment remain fundamental to early recognition. When clinical suspicion persists despite inconclusive laboratory, microbiological, and imaging findings, timely diagnostic surgical exploration should not be delayed, as it provides direct assessment of tissue viability while enabling prompt source control.
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