Magnetic Resonance Imaging in Adults Presenting With Severe Acute Infectious Cellulitis

Saïag, Philippe; Breton, C. Le; Pavlovic, Mira; Fouchard, Nathalie; Delzant, G; Bigot, Jean-Michel

doi:10.1001/archderm.1994.01690090074011

Cited by 59 publications

(8 citation statements)

References 33 publications

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“…Plain film radiographs may show pockets of gas within the soft tissue 4,8 . With magnetic resonance imaging, T2‐weighted images may reveal dome‐shaped areas of increased signal intensity in the hypodermis and fascia adjacent to normal‐appearing muscle 8,9 . On computed tomography, there may be decreased attenuation of the superficial fascia, indicative of necrosis, with relative sparing of the underlying muscle 8 …”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis: delay in diagnosis results in loss of limb

Varma

Stashower

2006

Int J Dermatol

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A 58‐year‐old man presented to the Emergency Room with a 1‐day history of severe pain in the left lower extremity preceded by several days of redness and swelling. He denied any history of trauma. He also denied any systemic symptoms including fever and chills. His past medical history was significant for diabetes, hypertension, deep vein thrombosis, and Evans’ syndrome, an autoimmune hemolytic anemia and thrombocytopenia, for which he was taking oral prednisone. Physical examination revealed a warm, tender, weeping, edematous, discolored left lower extremity. From the medial aspect of the ankle up to the calf, there was an indurated, dusky, violaceous plaque with focal areas of ulceration (Fig. 1). 1 Grossly edematous lower extremity with well‐demarcated, dusky, violaceous plaque with focal ulceration Laboratory data revealed a white blood cell count of 6.7 × 103/mm3[normal range, (4.5–10.8) × 103/mm3], hemoglobin of 11.5 g/dL (13.5–17.5 g/dL), and platelets of 119 × 103/mm3[(140–440) × 103/mm3]. Serum electrolytes were within normal limits. An ultrasound was negative for a deep vein thrombosis. After the initial evaluation, the Emergency Room physician consulted the orthopedic and dermatology services. Orthopedics did not detect compartment syndrome and did not pursue surgical intervention. Dermatology recommended a biopsy and urgent vascular surgery consultation to rule out embolic or thrombotic phenomena. Despite these recommendations, the patient was diagnosed with “cellulitis” and admitted to the medicine ward for intravenous nafcillin. Over the next 36 h, the “cellulitis” had advanced proximally to his inguinal region. His mental status also declined, and he showed signs of septic shock, including hypotension, tachycardia, and tachypnea. Vascular surgery was immediately consulted, and the patient underwent emergency surgical debridement. The diagnosis of necrotizing fasciitis was then made. Tissue pathology revealed full‐thickness necrosis through the epidermis with subepidermal splitting. Dermal edema was also present with a diffuse neutrophilic infiltrate (Fig. 2). This infiltrate extended through the fat into the subcutaneous tissue and fascia. Tissue cultures sent at the time of surgery grew Escherichia coli. Initial blood cultures also came back positive for E. coli. Anaerobic cultures remained negative. 2 Necrotic epidermis with subepidermal splitting. Marked dermal edema with mixed infiltrate and prominent neutrophils. Hematoxylin and eosin: original magnification, ×20 After surviving multiple additional debridements, the patient eventually required an above‐the‐knee amputation due to severe necrosis.

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Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis: delay in diagnosis results in loss of limb

Varma

Stashower

2006

Int J Dermatol

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“…The utility of imaging studies in diagnosing early streptococcal necrotizing fasciitis is uncertain, although some authors have reported promising results with MRI in differentiating cellulitis from necrotizing fasciitis [8,9]. Stamenkovic and Lew [10] performed frozen-section biopsy within 0-4 days (average, 21 h) of the onset of symptoms of necrotizing fasciitis, which led to earlier diagnosis and a statistically significant improvement in mortality when compared with cases in which the diagnosis was made on clinical grounds alone.…”

Section: The Initial Outpatient-physician Encounter In Group a Streptmentioning

confidence: 99%

The Initial Outpatient-Physician Encounter in Group A Streptococcal Necrotizing Fasciitis

Bisno

Cockerill

Bermudez

2000

Clinical Infectious Diseases

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Of 15 patients in whom the diagnosis of streptococcal necrotizing fasciitis was missed at initial outpatient evaluation, 8 died. Although influenza-like and gastrointestinal symptoms were common, the most consistent clinical clue was unrelenting pain out of proportion to the physical findings. Necrotizing fasciitis should be considered in patients presenting with the latter complaint, even if there is only mild or no fever or erythema.

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“…A shift to the left in the white blood-cell count and an increase in the erythrocyte sedimentation rate are probably the most helpful laboratory findings (4). MR imager and CT scanner are especially useful tools for the diagnosis (4,7,8).…”

Section: Discussionmentioning

confidence: 99%

Bacteroides fragilis Pyomyositis in a Patient with Multiple Myeloma

Katagiri

Shibuya²,

Takayasu³

1996

The Journal of Dermatology

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Pyomyositis is a bacterial infection with abscess formation affecting large skeletal muscles. It is predominantly caused by Staphylococcus aureus. The disease is common in tropical areas, but rare in temperate climates. We report a patient with multiple myeloma who developed a giant elastic tumor on the right thigh and a hen egg-sized tumor on the right upper arm. MR imaging revealed cystic spaces in the femoral quadriceps and brachial biceps muscles. A large amount of pus with foul smell was removed by incision, drainage and aspiration of the two tumors. The lesions were successfully treated with intravenous administration of antibiotics. Repeated bacterial cultures yielded only Bacteroids fragilis. To our knowledge, this is the first report of pyomyositis due to Bacteroides fragilis.

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Magnetic Resonance Imaging in Adults Presenting With Severe Acute Infectious Cellulitis

Cited by 59 publications

References 33 publications

Necrotizing fasciitis: delay in diagnosis results in loss of limb

Necrotizing fasciitis: delay in diagnosis results in loss of limb

The Initial Outpatient-Physician Encounter in Group A Streptococcal Necrotizing Fasciitis

Bacteroides fragilis Pyomyositis in a Patient with Multiple Myeloma

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