Necrotizing Fasciitis After Catgut Embedding for Weight Reduction: a Case Report and Review of Literature

Acupoint catgut embedding is a traditional Chinese medicine-based technique used to assist in obesity management by implanting absorbable sutures into specific acupoints for prolonged stimulation, potentially affecting metabolism, appetite, and digestion. While typically safe, this technique can lead to severe infections including necrotizing soft tissue infection and necrotizing fasciitis if performed in settings lacking rigorous aseptic standards. We present the case of a 20-year-old woman who developed severe pain in her lower abdomen and thighs one day before visiting the emergency department, following acupoint catgut embedding performed in an unregulated clinic. Physical examination showed redness, rapid skin discoloration, diffuse ecchymosis, and severe tenderness. A computed tomography scan revealed gas formations and diffuse fat stranding in affected areas, suggestive of an early-stage necrotizing infection. Broad-spectrum antibiotics and fluid resuscitation were administered under a tentative necrotizing fasciitis diagnosis, with surgical intervention initially scheduled. However, significant improvement in symptoms allowed deferral of surgery, and the patient was discharged after 11 days. This case underscores the risks of necrotizing soft tissue infection with acupoint catgut embedding when aseptic techniques may be compromised. Early recognition and prompt management of atypical symptoms, even in the absence of systemic toxicity, are crucial in preventing progression to necrotizing fasciitis. We highlight the necessity of standardized aseptic protocols and regulated environments for performing aesthetic procedures to ensure patient safety and minimize infection risks.