Necrotizing Fasciitis Complicating Pregnancy: A Case Report and Literature Review

Abstract

Necrotizing fasciitis is a rare, life-threatening surgical infection in pregnancy with high rates of morbidity and mortality. A 15-year-old primigravid woman, at 28 weeks of gestation with no significant previous medical history, was admitted to our hospital complaining of severe left lower extremity pain and high fever the last 72 hours. During clinical examination, she had a swollen, erythematous and tender to palpation inflamed skin over the medial aspect of the upper thigh without any evidence of injury. Incision drainage was performed immediately and she received broad spectrum antibiotics. During initial laboratory examinations, diabetes mellitus was diagnosed. There was no clinical improvement over the following days. Magnetic resonance imaging (MRI) revealed subcutaneous tissue inflammation and edema of infected tissues confirming the disease entity. Multidisciplinary therapy with immediate aggressive surgical debridement of necrotic tissues, multiple antibiotics, and intensive care monitoring was performed successfully. The patient's postoperative course was uncomplicated and skin defect was closed with split thickness skin grafting. Our case emphasized the potential immunosuppressive role of pregnancy state in conjunction with diabetes mellitus in the development of severe necrotizing soft tissue infections.

Necrotizing soft tissue infection in pregnancy

“…In this case, the patient's past medical history was unremarkable, suggesting that pregnancy might be as risk factor for necrotizing infection. We found only one similar case report on NSTI in pregnancy published in the English language, presenting a 15-year-old primigravid in the 29th week of pregnancy [10], since the majority of necrotizing infections related to pregnancy appears during the postpartum period (82.4%) [5]. In the presented case report by Nikolaou et al [10], diabetes was diagnosed incidentally at the time of hospital admission.…”

“…We found only one similar case report on NSTI in pregnancy published in the English language, presenting a 15-year-old primigravid in the 29th week of pregnancy [10], since the majority of necrotizing infections related to pregnancy appears during the postpartum period (82.4%) [5]. In the presented case report by Nikolaou et al [10], diabetes was diagnosed incidentally at the time of hospital admission. In addition to diabetes mellitus, pregnancy was suggested as a risk factor for necrotizing infection due to suppression of immune system during the second and third trimester and in postpartum period.…”

“…In the present case, rapidly progressive infection, treatment delay, and development of septic shock unfortunately led to intrauterine death. In another reported case by Nikolaou et al [10], necrotizing infection caused preterm delivery of viable male fetus weighing 1,470 g by normal labor despite tocolytic therapy. The baby died due to septicemia after 48 hours.…”

“…Initial finding in this case was not suggestive of NSTI, but rather of perianal abscess of cryptoglandular etiology, with one distinction -unusually intensive pain. In a previously mentioned case report, the diagnosis was established on the third day of hospitalization after unsuccessful treatment with incision and antibiotics, and after magnetic resonance imaging (MRI) confirmation [10]. According to data from literature, imaging techniques could be useful.…”

Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

“…In a retrospective study with 23 patients with NF in lower abdomen or pelvis, 34.7% had diabetes [17]. Obesity, which increases the infection risk during pregnancy and cesarean delivery, is also an important risk factor [18]. Open Journal of Obstetrics and Gynecology…”