Manejo multidisciplinario de fascitis necrotizante cervicofacial y mediastínica por patología autoinmune

Abstract

Introduction: Cervicofacial necrotizing fasciitis (CNF) is a rare and aggressive soft-tissue infection of the head and neck, accounting for approximately 2.6% of all soft-tissue infections, with a mortality rate ranging from 7% to 20%. When complicated by descending necrotizing mediastinitis (DNM), the prognosis worsens significantly. Patients with autoimmune diseases and associated immunosuppression are at particularly high risk, with atypical presentations that may mask classic signs and delay diagnosis. Objective: To synthesize current evidence on the multidisciplinary management of cervicofacial necrotizing fasciitis with mediastinal extension in patients with autoimmune pathology and immunosuppression. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to May 2026, following PRISMA guidelines. Original studies, systematic reviews, clinical guidelines, and case reports addressing CNF with mediastinal extension in immunosuppressed patients with autoimmune diseases were included. Results: A total of 847 records were identified, of which 58 studies met the eligibility criteria. The reviewed evidence confirms that CNF in immunosuppressed patients presents particular diagnostic challenges, with attenuation of classic inflammatory signs. Successful treatment requires a multidisciplinary approach integrating head and neck surgery, thoracic surgery, intensive care, infectious diseases, and rheumatology. Early and aggressive surgical debridement, targeted antibiotic therapy, and intensive care unit support constitute the pillars of treatment. Contrast-enhanced computed tomography is the imaging modality of choice. Conclusion: Cervicofacial necrotizing fasciitis with mediastinal extension in patients with autoimmune pathology and immunosuppression constitutes a highly lethal entity requiring a high index of suspicion, early imaging diagnosis, and aggressive multidisciplinary management.