Multifocal necrotising fasciitis: An overlooked entity?

SUMMARYA 35-year-old woman with a 3-day history of chickenpox, presented to the hospital in septic shock and with multifocal, non-adjacent lesions of necrotising fasciitis. Necrotising fasciitis is a rare yet life-threatening complication of chickenpox. Blood cultures and wound swabs confirmed the presence of Streptococcus pyogenes. The initial emergency management included oxygen, aggressive fluid resuscitation and antimicrobial therapy. Once the patient was stabilised, surgical management ensued. This included debridement and eventual grafting of the necrotic skin lesions. Intensive management and follow-up for 8 weeks were required before the patient was deemed fit for discharge. BACKGROUND

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“…This is also supported by the multifocality of the lesions 11. The patient's multifocal presentation made this case even rarer.…”

Section: Discussionmentioning

confidence: 54%

Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult

et al. 2013

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“…Classically, necrotising fasciitis spreads by direct invasion along fascial planes, leading to necrosis of the overlying tissue; however, a number of cases of multifocal necrotising fasciitis have now been reported, which tend to have much worse outcomes 2 3. Multifocal lesions may present synchronously as in our case, or after an interval of up to 3 days 4.…”

Section: Discussionmentioning

confidence: 59%

Multifocal necrotising fasciitis: a rarer presentation of a rare disease

2014

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“…Our patient had biopsy proven bilateral thigh NF without perineal involvement (Fournier gangrene), which makes this case even more intriguing. A recent review of cases showed the rarity of multifocal NF (MNF), just 33 reported cases from 1966–2011 21. Interestingly, a vast majority (86%) of the MNF were attributed to type II NF, unlike overall incidence of <20% among all cases of NF 1 21.…”

Section: Discussionmentioning

confidence: 99%

“…A recent review of cases showed the rarity of multifocal NF (MNF), just 33 reported cases from 1966–2011 21. Interestingly, a vast majority (86%) of the MNF were attributed to type II NF, unlike overall incidence of <20% among all cases of NF 1 21. To the best of our knowledge, MNF due to CA-MRSA has not yet been reported.…”

Section: Discussionmentioning

confidence: 99%

Bilateral thigh methicillin-resistantStaphylococcus aureusnecrotising fasciitis in a man with newly diagnosed Human Immunodeficiency Virus (HIV)

2017

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Methicillin-resistant Staphylococcus aureus (MRSA) necrotising fasciitis (NF) is rare and constitutes a medical and surgical emergency. We report a case of a 53-year-old man with type-2 diabetes mellitus and newly diagnosed HIV infection who presented with 1 week of progressively worsening bilateral sharp thigh pain. On presentation, he was febrile, tachycardic and had bilateral thigh erythema and mild tenderness without open wounds. He had leucocytosis, lactic acidosis and acute kidney injury. Urgent incision and drainage (I&D) was performed for suspected NF. Blood cultures and I&D were positive for MRSA. Biopsy of bilateral thighs showed NF. He was treated with wound washout and 6 weeks of intravenous antibiotics. After undergoing skin graft for wounds, he was discharged to physical rehabilitation. Here we report severe sepsis from bilateral thigh MRSA NF in a patient with newly diagnosed HIV.

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Multifocal necrotising fasciitis: An overlooked entity?

Cited by 24 publications

References 57 publications

Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult

Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult

Multifocal necrotising fasciitis: a rarer presentation of a rare disease

Bilateral thigh methicillin-resistantStaphylococcus aureusnecrotising fasciitis in a man with newly diagnosed Human Immunodeficiency Virus (HIV)

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