Multidisciplinary Management of Cervicofacial and Mediastinal Necrotizing Fasciitis Due to Autoimmune Pathology
DOI:
https://doi.org/10.70577/b3kd1a68Keywords:
Necrotizing fasciitis; cervicofacial; descending mediastinitis; autoimmune diseases; immunosuppression; multidisciplinary management.Abstract
Introduction: Cervicofacial necrotizing fasciitis (CNF) is a rare and aggressive soft-tissue infection of the head and neck, accounting for approximately 2.6% of all soft-tissue infections, with a mortality rate ranging from 7% to 20%. When complicated by descending necrotizing mediastinitis (DNM), the prognosis worsens significantly. Patients with autoimmune diseases and associated immunosuppression are at particularly high risk, with atypical presentations that may mask classic signs and delay diagnosis.
Objective: To synthesize current evidence on the multidisciplinary management of cervicofacial necrotizing fasciitis with mediastinal extension in patients with autoimmune pathology and immunosuppression.
Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to May 2026, following PRISMA guidelines. Original studies, systematic reviews, clinical guidelines, and case reports addressing CNF with mediastinal extension in immunosuppressed patients with autoimmune diseases were included.
Results: A total of 847 records were identified, of which 58 studies met the eligibility criteria. The reviewed evidence confirms that CNF in immunosuppressed patients presents particular diagnostic challenges, with attenuation of classic inflammatory signs. Successful treatment requires a multidisciplinary approach integrating head and neck surgery, thoracic surgery, intensive care, infectious diseases, and rheumatology. Early and aggressive surgical debridement, targeted antibiotic therapy, and intensive care unit support constitute the pillars of treatment. Contrast-enhanced computed tomography is the imaging modality of choice.
Conclusion: Cervicofacial necrotizing fasciitis with mediastinal extension in patients with autoimmune pathology and immunosuppression constitutes a highly lethal entity requiring a high index of suspicion, early imaging diagnosis, and aggressive multidisciplinary management.
Downloads
References
Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: A systematic review and meta-analysis. (2022). Head & Neck. https://doi.org/10.1002/hed.27029 DOI: https://doi.org/10.1002/hed.27029
Aydin, A., Revend, L., Revend, D., Schuck, O., & Dudde, F. (2025). Necrotizing fasciitis of the head and neck – clinical features, diagnostics, and management strategies. Oncoscience, 12, 219-225. https://doi.org/10.18632/oncoscience.639 DOI: https://doi.org/10.18632/oncoscience.639
Bandaru, S. S., Chirayil, P. T., Milhem, M. M., Almasri, R. M., & Almazrouei, M. (2025). Cervical necrotizing fasciitis in an uncontrolled diabetic male patient: A multimodal management approach. Cureus, 17(3), e81177. https://doi.org/10.7759/cureus.81177 DOI: https://doi.org/10.7759/cureus.81177
Cervical necrotizing fasciitis affects only immunocompromized patients? Diagnostic challenges, treatment outcomes and clinical management of eleven immunocompetent adult patients with a still fatal disease. (2020). PubMed. PMID: 32564018
Cervical necrotizing fasciitis with descending mediastinitis: Literature review and case report. (2011). Journal of Oral and Maxillofacial Surgery, 69(8), 2142-2149. https://doi.org/10.1016/j.joms.2011.02.127 DOI: https://doi.org/10.1016/j.joms.2011.02.127
Chaulk, R. C., Sahai, D., Raj, L., & Nayak, R. (2025). Etiology, diagnosis, and management of descending necrotizing mediastinitis: A narrative review. Mediastinum, 9. https://med.amegroups.org/article/view/9800 DOI: https://doi.org/10.21037/med-24-29
Cobzeanu, B. M., Moisii, L., Palade, O. D., Ciofu, M., Severin, F., Dumitru, M., Radulescu, L., Martu, C., Cobzeanu, M. D., & Bandol, G. (2025). Management of deep neck infection associated with descending necrotizing mediastinitis: A scoping review. Medicina, 61(2), 325. https://doi.org/10.3390/medicina61020325 DOI: https://doi.org/10.3390/medicina61020325
Descending necrotizing mediastinitis across age and host-status groups: Diagnosis, treatment phases, and outcomes in the literature, with an illustrative case. (2026). Infectious Diseases and Therapy. https://doi.org/10.1007/s40121-026-01397-2 DOI: https://doi.org/10.1007/s40121-026-01397-2
Gautam, S., Chapagain, P., & Lorenzo, E. (2025). Cervical necrotizing fasciitis with intractable hiccups. Cureus, 17(7), e88145. https://doi.org/10.7759/cureus.88145 DOI: https://doi.org/10.7759/cureus.88145
Kamada, K., Okamoto, T., Osoegawa, A., & Sugio, K. (2026). Narrative review of descending necrotizing mediastinitis, focusing on the etiology, classification-guided surgical management, treatments, and prognosis. Mediastinum. https://med.amegroups.org/article/view/11357 DOI: https://doi.org/10.21037/med-2025-1-46
Kryeziu, K., Myftiu, B., Hajdari, B., Halihajdaraj, R., & Stubljar, D. (2024). Efficacity of hyperbaric oxygen therapy for necrotizing fasciitis in the maxillofacial region: A review of the literature. International Wound Journal, 21(6). https://doi.org/10.1111/iwj.70000 DOI: https://doi.org/10.1111/iwj.14915
Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: A case report. (2010). Journal of Medical Case Reports, 4, 367. (Sin DOI) DOI: https://doi.org/10.1186/1752-1947-4-367
Okai, N., Otsuka, Y., Masaki, S., Kudo, M., & Watanabe, T. (2024). Necrotizing fasciitis of the serratus anterior in a patient treated with infliximab and prednisolone for ulcerative colitis and rheumatoid arthritis. Cureus, 16(4), e59346. https://doi.org/10.7759/cureus.59346 DOI: https://doi.org/10.7759/cureus.59346
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
Roberson, J. B., Harper, J. L., & Jauch, E. C. (1996). Mortality associated with cervicofacial necrotizing fasciitis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 82(3), 264-267. https://doi.org/10.1016/S1079-2104(96)80349-3 DOI: https://doi.org/10.1016/S1079-2104(96)80350-7
Staten, I., Truong, A., & Miller, A. C. (2020). Periapical abscess progressing to parotitis and descending necrotizing mediastinitis with thoracic abscess in a patient on etanercept: A case report. International Journal of Critical Illness and Injury Science, 10(4), 220-223. https://doi.org/10.4103/IJCIIS.IJCIIS_75_20 DOI: https://doi.org/10.4103/IJCIIS.IJCIIS_75_20
The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. (2014). Journal of Oral and Maxillofacial Surgery, 72(12), 2456-2461. https://doi.org/10.1016/j.joms.2014.05.015 DOI: https://doi.org/10.1016/j.joms.2014.05.015
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Myriam Estefania Jara Pila, Ismael Adrián Zhimnay Morocho, Angélica Maritza Medina Campos, Josué David Águila Velasco, Cristhian Joel Pinos Chango (Autor/a)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
