Necrotizing fasciitis associated with Enterococcus avium in a Type 2 Diabetes Mellitus patient: A case report

Abstract

Necrotizing fasciitis (NF) is a rapidly progressive and life-threatening infection of the soft tissue. Diabetic patients are especially at risk due to impaired immunity and poor wound healing. We report a case of NF in a 60-year-old Indonesian man with poorly controlled type 2 diabetes. He presented with a rapidly worsening wound on his right foot following a minor abrasion, along with signs of sepsis and early organ dysfunction. His LRINEC score was 10. He underwent urgent surgical debridement and below-knee amputation. Despite initial improvement, he deteriorated and died from septic shock on day five. Wound culture revealed Enterococcus avium, a rare pathogen that is resistant to several antibiotics but sensitive to vancomycin and linezolid. This case highlights the severe progression of NF in diabetic patients and the need for early recognition and aggressive management. The presence of E. avium underscores the potential role of uncommon pathogens in serious infections among immunocompromised individuals. Delayed referral and lack of timely antibiotic adjustment may have contributed to the fatal outcome. Prompt diagnosis, early surgery, and appropriate antibiotics are crucial in managing NF. Clinicians should be vigilant in monitoring diabetic patients and consider rare pathogens, such as E. avium, in cases of severe infections.