DISCUSSION
A carbuncle manifests as the coalescence of several furuncles ensuing in
a single inflammatory mass with multiple draining sinus tracts. It
usually starts as a furuncle that affects areas with thick skin e.g.
nape of the neck and back. Staphylococcus aureus is the most common
cause and DM stands among predisposing conditions as in our patient.
Although the infection may extend deep into the subcutaneous tissues
[3], evolution to the NF rarely occurs.
Necrotizing fasciitis is characterized by rapidly progressive infection
of subcutaneous tissue and fascial planes leading to widespread necrosis
and systemic toxicity [4]. It could be life-threatening with a
mortality rate ranging from 20 to 60% [5]. The most common sites of
involvement are the extremities and the perineum (Fournier gangrene)
[6]. Early signs of NF include cellulitis, and fever; although, it
can progress at a frightening rate. The subcutaneous tissues may become
hard and “woody” on palpation with discharge of a thin, malodorous
fluid resulting from fat tissue and fascial necrosis. Patients can
become extremely toxic enduing in sepsis and shock. Saving the patient
life needs prompt diagnosis, immediate and aggressive surgical
debridement, and broad-spectrum antibiotic therapy. Subsequent surgeries
are necessary to remove all necrotic tissues [6,7].
Delayed presentation of NF due to the COVID-19 has been described
[2,6]. To our knowledge, the evolution of NF from the carbuncle has
not been reported yet in the COVID-19 pandemic.
Although undiagnosed DM promotes the progression of carbuncle to the NF,
delay in presentation due to the COVID-19 social distancing plans also
can pave the way for this progression.
In conclusion, this case highlights the importance of early diagnosis
and management in preventing the progression of a clinically simple to
treat condition to a critical potentially lethal illness. Radical
surgery and antibiotic therapy along with diabetes control saved the
patient in the last hours.