A rare case report of vulvar necrotizing fasciitis in a healthy patient

Abstract

HighlightsNF should be considered regardless of atypical location and lack of associations.Clinical findings are important indicators when diagnosing NF.Immediate surgical intervention should be performed upon suspicion of NF.

Multidrug resistant Proteus mirabilis and Escherichia coli causing fulminant necrotising fasciitis: a case report

“…The key to successful management of patients with necrotizing soft tissue infections relies on early recognition, prompt and aggressive surgical debridement with targeted antibiotic therapy [ 3 , 10 , 14 ]. Early diagnosis of NF remains a challenge partly due to nonspecific skin findings causing it to be misdiagnosed as cellulitis [ 2 , 5 , 14 ]. This patient was initially managed as cellulitis prior to referral, and this delayed the diagnosis of NF.…”

“…Kobayashi et al showed that delays in surgical treatment of > 12 h are associated with an increased number of surgical debridement, higher incidence of septic shock and acute kidney injuries in patients with necrotizing soft tissue infections [ 15 ]. Unusual location of soft tissue infections, lack of associated co-morbidities and/or risks factors, absence of any history of preceding trauma or an obvious breech in the continuity of skin or mucosa, or a low Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score thus excludes the diagnosis of NF [ 2 , 4 ]. Our patient presented no specific risk factors for NF and no history of initiating trauma or breech in skin continuity but however developed a life threating NF.…”

“…The LRINEC scoring system has not yet achieved wide-spread use due to some investigations like C-reactive protein which requires over 24 h for the results and is absent in most resource-limited settings. The controversial views of some authors with many papers questioning its usefulness in early recognition of LRENIC in recognising NF have also limited it use [ 2 , 17 ]. Many studies have validated the ability of the LRINEC in detecting NF and differentiating it from other soft tissue infections like cellulitis that may clinically present in a similar fashion while others haven’t [ 16 , 18 ].…”

“…Necrotizing fasciitis (NF) is a rare soft tissue infection characterized by rapid progressive necrosis with relative sparing of underlying muscles [ 1 , 2 ]. Patients with NF usually present with nonspecific features like fever, excruciating pain, oedematous and erythematous skin lesions that often rapidly deteriorate to haemorrhagic blebs or fluid-filled bullae and gangrenous necrosis [ 3 , 4 ].…”

“…Over 70% of cases of NF are caused by polymicrobial organisms with most cultures yielding a mixture of aerobic and anaerobic organisms [ 5 – 7 ]. The most common pathogens isolated from cultures are gram positive organisms like β -hemolytic group A streptococcus, Staphylococcus aureus , bacillus species, enterococci species and gram negative organisms such as Klebsiella pneumonia, Pseudomonas aeroginosa , Serratia species , Escherichia coli , Clostridium species, Fusobacterium species, and Prevotella species [ 2 , 7 , 8 ]. NF carries a high morbidity and mortality especially when diagnosed late [ 5 , 9 ] necessitating prompt diagnosis and timely treatment with radical surgical debridement and empiric broad spectrum antibiotic therapy [ 2 , 10 ].…”