Klebsiella pneumoniae necrotizing fasciitis on theupper lip in a patient with uncontrolled diabetes

ABSTRACT

A 60-year-old woman with a history of diabetes mellitus and chronic renal failure was admitted tothe hospital with severe pain in the upper lip, which began 4 days prior to admission, accompaniedby a bullous lesion and suspected cellulitis in the upper lip. Immediately after admission, asthe patient´s general condition worsened, tests revealed a non-ST elevated myocardial infarction,septic embolism of the lung, as well as septic shock. Her upper lip suddenly presented a gangrenousand necrotic change, which the tissue and blood culture confirmed to be a Klebsiella pneumoniaeinfection. After a quick response, the patient’s general condition improved. Subsequently,serial debridement was performed to effectively clear away the purulent discharge. While undergeneral anesthesia, the process confirmed full-layer necrosis of the upper lip including the orbicularisoris muscle. Almost half of the entire upper lip sustained a full-layer skin and soft tissue defect,with scar contracture. Six months later, to correct the drooling and lip sealing following thedefects, a scar release and an Abbe flap coverage were performed considering both functionaland aesthetic aspects. The follow-up revealed a favorable corrective result of the upper lip drooling,and the patient was satisfied from a functional perspective.