Life-threatening cervical necrotizing fasciitis caused by congenital pyriform sinus fistula: A case report

We report the case of a 2-year-old boy who presented with cough for one week and fever for 4 days. On admission, physical examination revealed restricted neck movement and a firm, tender mass on the left side of the neck with a well-defined border and limited mobility. Within 24 h, the mass enlarged rapidly, and blue-red discoloration of the overlying skin appeared and progressed quickly. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 9. The child underwent urgent surgical debridement. Intraoperative findings confirmed the presence of a congenital pyriform sinus fistula (CPSF) complicated by cervical necrotizing fasciitis (CNF). Wound cultures yielded oropharyngeal flora dominated by anaerobic bacteria. CNF is rare but life-threatening condition, most commonly arising from odontogenic infections. CNF secondary to CPSF is extremely uncommon and has rarely been described in the literature. This case highlights CPSF as a potential underlying cause in children with unexplained cervical necrotizing soft-tissue infection. Although necrotic complications of CPSF are exceedingly rare, clinicians must remain vigilant for this severe and potentially fatal presentation.