Monomicrobial Necrotizing Fasciitis and Emphysematous Cystitis: Autopsy Report and Literature Review

Abstract

Necrotizing fasciitis (NF) and emphysematous cystitis (EC) are life-threatening conditions even with appropriate and rapid medical and surgical treatment. Herein, we report a case of a 65-year-old male patient who presented with concomitant EC and NF of the left thigh. The patient was managed with an emergency debridement of the left thigh shortly after arrival along with broad-spectrum antibiotic and fluid resuscitation. Tissue culture was positive for Clostridium perfringens. Despite the prompt management, the subcutaneous emphysema extended to gluteal, scrotal regions and to posterior abdominal wall muscles. The evolution was complicated by distributive shock and subsequently by multiple organ failure leading to death within 24 hours after the emergency room admission. To the best of our knowledge, this is the first case of concomitant EC and NF caused by Clostridium perfringens leading to death despite intensive treatment. Moreover, it is the first case providing clinical, radiologic, microbiologic and postmortem pathologic results.