Time against tissue: case reports of fungal necrotizing fasciitis and the cost of delayed aggressive interventions.

BACKGROUND: Necrotizing fasciitis is a rare disease that causes the necrosis of subcutaneous tissues and muscle fascia in patients, and if not diagnosed and treated in due time may lead to the extreme morbidity and even death, with the mortality rate ranging from 6 to 33%. Fungal necrotizing fasciitis is even more rare and life threatening because of aggressive infection and less response to medical treatment. Literature has reported three times higher mortality rate in patients, who had positive fungal cultures and requiring multiple surgical detriments. CASE PRESENTATIONS: We are reporting cases of patients who were diagnosed and managed with fungal necrotizing fasciitis in a tertiary care hospital. CASE 1: A 45-year-old farmer with a non-healing abdominal wound later diagnosed with fungal necrotizing fasciitis, which improved after surgical debridement and anti-fungal treatment. The patient recovered after follow-up treatments. CASE 2: A 74-year-old diabetic man developed a groin wound that progressed to necrotizing fasciitis. Despite treatment, fungal cultures revealed growth of Candida tropicalis, Apophysomyces elegans, and Rhizopus species. The patient’s condition deteriorated and he passed away after the family opted for comfort care. CASE 3: A 54-year-old diabetic male involved in a road traffic accident developed sepsis and necrotizing fasciitis. Despite treatment and support the patient succumbed to his condition. CONCLUSION: Fungal necrotizing fasciitis, particularly in immunocompromised patients, is associated with high morbidity and mortality due to delayed recognition and treatment. Early surgical debridement along with empirical antifungal therapy should be considered standard practice. The report emphasizes the importance of early fungal cultures and timely, aggressive treatment to reduce complications and improve patient outcomes.