A Case Report of Rapidly Necrotizing Fasciitis Post-Falling Down Treated Reconstructively

Abstract

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can result in fast tissue loss, necrosis, and potentially fatal acute sepsis. Diabetes, cancer, alcohol abuse, and chronic liver and renal disease are all risk factors for NF. In this case report, a 19-year-old man with a negative past medical and surgical history was diagnosed with aggressive rapidly progressive necrotizing fasciitis of the left lower extremity after a recent history of falling down from a skateboard. A successful treatment with long-term debridement surgeries followed by reconstructive surgery with skin grafting was made. Although the severity of this condition, the patient was able to resume a normal range of motion of the concerned extremity. NF has been described in the literature, but early diagnosis, which is crucial for successful management, rests a challenge.

Culture Negative Necrotizing Fasciitis in the Setting of Chronic Lymphedema: A Case Report

“…5 The patient in this case report lacked some of the typical risk factors reported in the literature, including recent trauma or wounds (30-70% of the time), recent surgery near the affected site (3-4%), diabetes (~45%), consumption of raw or uncooked seafood, or exposure to marine bacteria including Vibrio spp., Aeromonas spp., or Shewanella spp. 5,6 However, the patient did have a history of chronic lymphedema on the ipsilateral side secondary to a history of breast adenocarcinoma treated with radical mastectomy, chemotherapy, and radiation. While the rate of association between chronic lymphedema and necrotizing fasciitis is unknown, Hara et al previously presented a case of a 70-year-old woman with a history of total hysterectomy and pelvic lymphadenopathy for uterine cancer with subsequent chronic lower extremity lymphedema confirmed with lymphoscintigraphy that went on to develop rapidly progressing necrotizing fasciitis of the left thigh and lower leg.…”

“…Furthermore, systemic symptoms, including fevers (up to 40% of the time), hypotension (21%), and tachycardia (59%), while commonly associated with necrotizing fasciitis, are not essential for early diagnosis and often represent an impending rapid decline in the patient's overall status. 6 Cantarella et al presented a case of necrotizing fasciitis of the gluteal musculature secondary to intramuscular injection of muscle relaxants where the patient went into septic shock peri-operatively despite reaching the operating room for debridement within 5-hours of presentation and prompt administration of broad-spectrum intravenous antibiotics. 8 Cases like these underscore that timely diagnosis of necrotizing fasciitis means being ahead of the clinical findings rather than waiting for them to occur.…”