A case of fatal necrotizing fasciitis after intramuscular administration of diclofenac

Abstract

Necrotizing fasciitis is a rapidly progressive soft tissue infection that involves subcutaneous fat and spreads along the fascial planes. This disease has a potentially fatal outcome if not recognized in early. Several cases have been reported of a possible association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the development or aggravation of necrotizing fasciitis. This association is still a subject of controversy. In this article we present a case of fatal necrotizing fasciitis occurring in association with intramuscular injections of diclofenac in a patient who was admitted for the symptoms of a urinary stone. Our opinion is that the intramuscular injections caused a locally aseptic necrosis, which was secondarily invaded by. Since this incident, our policy is to avoid the use of intramuscular injections of diclofenac and other NSAIDs in cases of potentially infectious diseases.

Mediastinum Drainage by Cervicotomy in the Neck and Mediastinum Cellulitis: About 12 Cases

“…An association between cellulitis complicated by odontogenic mediastinitis and NSAID use was reported in several other studies [6][7][8]. Cellulitis other than cervicofacial has also been reported, with NSAIDs implicated in evolution toward fatal necrotizing fasciitis [9]. This correlation may be explained by the action mechanism of NSAIDs against inflammation, which is after all basically a non-specific defense mechanism against microbial invasion.…”

Parenteralna Uporaba Protibolečinskih Zdravil Pri Bolečini V Križu V Družinski Medicini / Parenteral Use of Analgesics in Low Back Pain in Family Medicine

“…Bolniki jih pogosto zahtevajo, ker menijo, da zdravilo, aplicirano v injekciji, hitreje in bolje olajša bolečino od drugih, manj invazivnih načinov aplikacije zdravil ter jim omogoča hitrejšo vrnitev na delo. Zaradi odsotnosti dokazov o večji učinkovitosti in dodatnem tveganju za zaplete pa se parenteralna uporaba zdravil pri bolečini v križu odsvetuje (20)(21)(22). V Sloveniji do zdaj še ni bilo narejene raziskave, ki bi ugotovila, kako pogosto in pri katerih bolnikih se zdravniki družinske medicine odločajo za uporabo aplikacije zdravil v injekciji pri bolečini v križu.…”

“…V literaturi ni zadostnih dokazov, ki bi podpirali uporabo parenteralnih zdravil pri bolečini v križu (20,33). Kortikosteroidi, ki jih pri bolečini v križu običajno apliciramo parenteralno, so neučinkoviti v zmanjševanju bolečine in nimajo jasnih dokazov o vplivu na izboljšanje funkcijskega stanja (19),uporaba nesteroidnih antirevmatikov v injekciji pa je povezana z večjo možnostjo zapletov kot pri drugih načinih aplikacije zdravila (anafilaktična reakcija, možnost poškodbe živca, lokalni zapleti, kot so vnetja in krvavitev na mestu aplikacije) (21,22). Aplikacija injekcije zahteva prihod bolnika k zdravniku in predstavlja nepotrebno obremenitev za zdravstveno osebje in bolnika ter nepotreben strošek za bolnika in zdravstveno zavarovalnico.…”

Necrotizing fasciitis: a surgical emergency

“…NSAIDs are often used to treat the NF non-specific early symptoms. Case reports and case series, focused especially on NF related to severe invasive group A streptococcal infections in patients treated with NSAIDs, have been published, suggesting that these drugs may increase the risk of developing NF [16,[21][22][23].…”