Clinical Features of Neutrophilic Dermatosis Variants Resembling Necrotizing Fasciitis

Sanchez, Isabelle M.; Lowenstein, Stefan E.; Johnson, Kent C.; Babik, Jennifer M.; Haag, Carter; Keller, Jacob B.; Ortega‐Loayza, Alex G.; Cohen, Jarish N.; McCalmont, Timothy H.; Demer, Addison M.; Mansh, Matthew; Hylwa, Sara; Liu, Jing; Shinkai, Kanade

doi:10.1001/jamadermatol.2018.3890

Cited by 44 publications

(66 citation statements)

References 18 publications

(54 reference statements)

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“…Because none of the previously mentioned signs provided a sufficient sensitivity when considered separately, approaches combining several clinical findings have been proposed and achieved better diagnostic yields than did each individual finding [80]. In atypical cases, involvement of dermatologists can aid in the differential diagnosis of NSTI from rare mimics such as pyoderma gangrenosum [81].…”

Section: Clinical Picturementioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

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Background: Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. Objectives: To review all aspects of care for a critically ill individual with NSTI. Sources: Literature search using Medline and Cochrane library, multidisciplinary panel of experts. Content: The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial. Implications: Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.

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Section: Clinical Picturementioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

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“…NND, such as necrotizing SS [ 2 ], present with significant progression of cutaneous disease with systemic symptoms, which can resemble NF clinically and histopathologically [ 6 ]. As opposed to typical SS, in which neutrophilic infiltration primarily involves the dermis and occasionally the subcutaneous fat, necrotizing SS is a deeper process involving the fascia and skeletal musculature [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, as observed in this case, the cutaneous and systemic features of NF can mimic non-infectious dermatologic conditions with multisystem involvement, leading to delayed diagnosis. Sanchez et al proposed a set of diagnostic criteria to assist with the differentiation of NND from NF, which are included in Table 2 along with features noted by other clinicians [ 6 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sanchez et al proposed a set of diagnostic criteria to assist with the differentiation of NND from NF, which are included in Table 2 along with features noted by other clinicians [ 6 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several cases of NND misdiagnosed as NF have been reported in the dermatologic literature [ 2 , 6 , 18 , 19 ]. A case series involving 54 patients with NND revealed that 94% were initially given a diagnosis of NF [ 6 ]. This alarming rate of misdiagnosis underscores the pressing need to educate clinicians about NND.…”

Section: Discussionmentioning

confidence: 99%

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Necrotizing neutrophilic dermatosis: A diagnostic challenge with a need for multi-disciplinary recognition, a case report

Gowda

Christensen

Polly

et al. 2020

Annals of Medicine and Surgery

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Introduction Necrotizing neutrophilic dermatoses can clinically resemble necrotizing fasciitis and therefore pose a diagnostic and therapeutic challenge. Given their similar presentations, misdiagnosis and inappropriate or delayed treatments are possible. Presentation of case We discuss the case of a woman with acute myeloid leukemia who presented with fevers, chills, cough, and a leg wound. She underwent amputation of her lower extremity after she was presumed to have necrotizing fasciitis; however, symptoms persisted. She was ultimately diagnosed with and treated for necrotizing Sweet's syndrome with notable clinical improvement. Discussion Both, necrotizing neutrophilic dermatoses and necrotizing fasciitis, grossly affect the skin and are associated with rapidly progressing systemic features including fevers, chills, leukocytosis, and elevated inflammatory markers. Recent literature in dermatology addresses these similarities and the appropriate approach to management; however, it is critical that medical and surgical subspecialties have an understanding of necrotizing neutrophilic dermatoses and their clinical presentations, diagnostic approaches, as well as therapeutic interventions. Familiarity with this entity can mitigate the risk of misdiagnosis, morbidity, and mortality. Conclusion With this report, we seek to review the features that are suggestive of and aid in the diagnosis of necrotizing neutrophilic dermatoses to help prevent significant and avoidable morbidity.

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