Necrotizing Fasciitis: Expect the unexpected

Mujdragić

et al. 2021

Cureus

IntroductionNecrotizing fasciitis is a severe inflammatory disease of the body's soft tissue characterized by spreading rapidly and high mortality. Rapid surgical intervention along with other supportive measures of treatment have a great impact on the outcome of treatment. Material and methodsThis study was conducted by a retrospective medical record review of all patients with a microbiologically and clinically confirmed diagnosis of necrotizing fasciitis who were admitted to the general surgery department at the General Hospital Novi Pazar, Serbia, during the period between 2017 and 2020. Demographic, clinical, laboratory, and microbiology data were analyzed. ResultsA total of 13 cases were identified, which represents 0.21% of the total number of patients treated at the surgical department during the period January 2017 to November 2020. The mean age of patients was 55 years, with a male/female ratio of 1:1.6. All of them had at least one comorbidity and more than half had three or more. Diabetes, cardiovascular diseases, and obesity were the most common comorbidities. The most common causes of infection were Klebsiella spp, Pseudomonas aeruginosa, S. pyogenes, and S. aureus. All patients received multiple surgical interventions (mean 2.3). ConclusionTreating necrotizing fasciitis requires a multidisciplinary approach. Early diagnosis and rapid clinical response allow for better disease outcomes. Getting to know more about necrotizing fasciitis will help doctors make better decisions when treating it.

Section: Introductionmentioning

confidence: 99%

Necrotizing Soft Tissue Infection: A Single-Center Retrospective Study of Treatment and Outcomes

Mujdragić

et al. 2021

Cureus

“…19 With regard to considering the optimal management, Khalid et al reported necrotizing soft tissue infections being associated with considerable morbidity and mortality, and delayed recognition and treatment can have severe implications. 20 As stated previously, Kihiczak et al have reported that prompt diagnosis and treatment are essential, with surgical debridement and antibiotic therapy are the primary treatment options. 7 Marszał and Bielecki stated early and radical surgical excision of all affected tissue is the treatment of choice.…”

Section: Discussionmentioning

confidence: 92%

“Stocking Pattern Metabolic Captivity” of Legs on 18F-FDG PET-CT in Necrotizing Fasciitis: Potential Complimentary Role in Differential Diagnosis and Assessment of Disease Extent in a Life-Threatening Condition

Sonavane

Basu

2022

World J Nucl Med

A rare and fatal life-threatening case of necrotizing fasciitis (initially presenting with skin-deep superficial lesions and clinical suspicion of paraneoplastic syndrome) is described, who was finally diagnosed with the help of fluorodeoxyglucose-positron emission tomography (FDG-PET)/computed tomography (CT) as more extensive infectious process. A 36-year-old male presented with bilaterally symmetrical cutaneous lesions involving lower limbs that rapidly progressed to ulcerative lesions and pancytopenia. In view of suspicion of paraneoplastic manifestation, the patient underwent 18F-FDG-PET/CT to rule out any underlying malignancy. The FDG-PET/CT findings confirmed hypermetabolism circumferentially along the fasciae of bilateral lower extremities while sparing muscles and subcutaneous fat from below the knee till toe with diffused hypermetabolic marrow, and no evidence of focal disease suggesting malignancy. Biopsy turned out to be superficial necrolytic fasciitis. The patient's condition deteriorated and, 20 days following the scan, the patient succumbed secondary to severe pancytopenia and hypotension. The case raises the importance of high degree of suspicion and prompt diagnosis of this condition, where FDG-PET/CT imaging can play a valuable complimentary role. Such awareness could be lifesaving due to early optimal treatment in the disease course.

“…Necrotizing fasciitis is a serious and potentially life-threatening soft tissue infection that should be promptly handled. A multidisciplinary team should be involved in managing this aggressive condition while continuously monitoring patient hemodynamics in a controlled setting [ 12 ]. NF is a surgical emergency requiring wide and extensive debridement and reconstructive surgery [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Salmonella typhimurium necrotizing fasciitis: a case report

et al. 2023

Background Necrotizing fasciitis is an aggressive disease that causes necrosis in the muscular fascia and subcutaneous tissues. The infection spreads rapidly along the fascia and perifascial planes, followed by extension of the infection to nearby soft tissues and muscles. Necrotizing fasciitis can be attributed to different pathogens, namely Staphylococcus aureus, group A streptococci, and Clostridium perfringes. Only a few cases of skin and soft tissue infections from Salmonella species have been reported to date. Herein we report a case of Salmonella non-typhi necrotizing fasciitis, an exceedingly rare entity. This case report may serve as a potential management plan in similar cases in light of the scarcity of evidence. Case presentation A 20-year-old Caucasian male patient with congenital cardiac anomaly presented with diarrhea and unilateral lower extremity cellulitis causing septic shock. Cultures from blood and the bullae associated with the lower extremity cellulitis grew Salmonella typhimurium. Surgical debridement was performed. Intraoperative tissue cultures were positive for Salmonella typhimurium, and surgical pathology confirmed the diagnosis of necrotizing fasciitis. After a total of 6 weeks of appropriate antimicrobial therapy, another surgical debridement was executed for poor wound healing. New intraoperative cultures grew Fusarium species, and the patient received voriconazole with an adequate response. Immunologic studies showed humoral and cellular immunodeficiency. Conclusion It is important to maintain a high index of suspicion for rare entities that can cause skin and soft tissue infections, such as Salmonella non-typhi, in particular in immunosuppressed patients where a delay in diagnosis and management may have significant morbidity and mortality.