Necrotizing Fasciitis: Case Report and Review of Literature

Abstract

We report a case of necrotizing fasciitis of the lower limb. This medico-surgical emergency is a life-threatening invasive soft-tissue infection which primarily involves the fascia superficialis and rapidly extends along subcutaneous tissue with relative sparing of skin and underlying muscles. Clinical presentation includes fever, signs of systemic toxicity and pain out of proportion to clinical findings. Paucity of cutaneous findings early in the course of the disease makes diagnosis challenging. The confirmation of the diagnosis is often made after surgical debridement. Delay in diagnosis and/or treatment correlates with poor outcome, leading to sepsis and/or multiple organ failure. Radiologic studies including plain radiographs, CT-scan or MRI may help to diagnose necrotizing fasciitis. Prompt surgical debridement, intravenous antibiotics, fluids and electrolytes management and analgesia are mainstays of the therapy. Adjuvant treatments like clindamycin, hyperbaric oxygen therapy and intravenous immunoglobulins are discussed.

Under Treated Necrotizing Fasciitis Masquerading as Ulcerated Edematous Mycobacterium ulcerans Infection (Buruli Ulcer)

“…Pain disproportionate to local findings may be present and should be a clue to consider NF. [11][12][13][14] In our patient, ampicillin therapy prescribed in the village probably significantly modified the initial clinical picture. Moreover, we presume that antibiotic therapy had rendered many gram-positive organisms nonstainable by the Brown-Brenn method.…”

“…[10][11][12][13][14]25 Abnormal inflammatory tests are frequent in cases of NF. Laboratory tests in our case showed a neutrophilia and increased ESR.…”

Sepsis, parenteral vaccination and skin disinfection

“…Necrotizing fasciitis is an infection of the subcutaneous tissue (between the skin and the underlying muscle) which often overlaps with myconecrosis and is complicated by sepsis 78 . It has been classified 78 in 4 groups; Type 1 (polymicrobial), Type 2 (Group A Streptococcus), Clostridium fasciitis and Clostridium myonecrosis.…”

“…It has been classified 78 in 4 groups; Type 1 (polymicrobial), Type 2 (Group A Streptococcus), Clostridium fasciitis and Clostridium myonecrosis.…”

Necrotizing Fasciitis Caused by Serratia marcescens After Venous Access Port Implantation in a Child With Acute Lymphoblastic Leukemia

“…The latter is most often caused by Streptococcus pyogenes. 4,5 One of the possible, albeit rare causes of NF is infection with Serratia marcescens, a gram-negative Bacillus, belonging to the Enterobacteriaceae family.…”