Post-Cesarean Necrotizing Fasciitis as a Diagnostic Challenge in the Postpartum Period: Disproportionate Pain and Fulminant Progression. Case Report

Abstract

Introduction: Surgical site infections following cesarean section are among the most frequent obstetric complications, with reported rates ranging from 2% to 15% of cesarean deliveries. Within this spectrum, necrotizing fasciitis is an uncommon but potentially fatal condition. Case report: We present the case of a 37-year-old woman in the postoperative puerperium who presented on the fourth postoperative day with pain at the surgical site, associated with local signs of infection, elevated inflammatory markers, and an initial suspicion of an intra-abdominal collection, which was dismissed by the subsequent on-call team. During her clinical course, she developed persistent fever after 24 hours of antibiotic therapy, increased inflammatory markers, and elevated serum lactate. Therefore, antibiotic coverage was broadened and computed tomography was performed, showing findings compatible with necrotizing fasciitis. Urgent surgical management was undertaken, followed by transfer to the intensive care unit. The patient required a total of seven surgical interventions and prolonged antibiotic treatment for more than 20 days, with favorable clinical evolution, decreased inflammatory markers, and subsequent hospital discharge. Conclusion: Suspected post-cesarean necrotizing fasciitis is challenging due to the nonspecific initial presentation; however, rapid progression should increase clinical suspicion and prompt urgent evaluation. Imaging may contribute to determining disease extent but should not delay early surgical treatment. Management requires a multidisciplinary approach based on surgical interventions, antibiotic therapy, and supportive measures according to disease severity.