Isolated Chest Wall Necrotizing Fasciitis: An Unusual Fatal Manifestation of Extrapulmonary Tuberculosis

Primary tuberculosis of the chest wall is a rare disease and very difficult to diagnose without clinical suspicion. Here, we present an unusual case of necrotizing fasciitis due to an aggressive form of chest wall tuberculosis. A 22-year-old male presented in emergency with acute-onset swelling and redness over the right side of the neck and chest wall. He had no history of any drug reaction, trauma, and unknown bite. The patient underwent aggressive debridement followed by split-thickness graft under intensive care monitoring. Radiological imaging and Ziehl-Neelsen (ZN) staining of pleural fluid revealed no evidence of pulmonary tuberculosis. Special investigations such as cartridge-based nucleic acid amplification test and ZN staining from pathological skin or subcutaneous tissue revealed active tuberculosis; therefore, antitubercular drugs were started.