Necrotizing fasciitis with prior leprosy: a case report

Abstract

<p class="abstract">Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with a high misdiagnosis rate. Here, we present the case of NF with hypoesthesia due to prior leprosy in a limited resource area. Laboratory risk indicator for NF (LRINEC) score was used to determine the diagnosis of NF. Resuscitation and broad-spectrum antibiotic were initiated, followed by surgical debridement due to lack of wound improvement and skin graft to cover the wound was done. This case report highlights the usage of LRINEC score to reduce misdiagnosis, ensure early diagnosis, and improve patient management in NF with masking effect.</p>

Necrotizing Soft Tissue Infection of the Upper Extremity as a Manifestation of Hansen’s Disease

“…3 However, NF associated with leprosy has rarely been reported. Teng et al 7 recently described a case of NF of the right hand and forearm in the setting of marked hypoesthesia as a complication of leprosy. 7 In their study, the authors attempt to elucidate the challenge in diagnosing NSTI in patients with underlying hypoesthesia.…”

“…Teng et al 7 recently described a case of NF of the right hand and forearm in the setting of marked hypoesthesia as a complication of leprosy. 7 In their study, the authors attempt to elucidate the challenge in diagnosing NSTI in patients with underlying hypoesthesia. They discuss how decreased sensation can mask some of the most common clinical features of NF, and they recommend the use of the Laboratory Risk Indicator for Necrotizing Fasciitis score in such cases to ensure early diagnosis.…”

“…9 Although its exact pathogenesis remains unclear, it seems to involve uninhibited multiplication of bacilli leading to diffuse infiltration of the dermis in an immunocompromised host. 7,8,10 Other authors have hypothesized that Lucio's is a hypersensitivity reaction to high titers of circulating antigens resulting from a synergistic reaction between M leprae and gram-positive or gramnegative cocci causing superimposed skin infections. 11 Lucio's leprosy has also been compared with vasculopathies, with obstructive microthromboembolism and presence of antiphenolic glycolipid IgM antibodies and immune complexes in blood vessels of the skin and/or other organs.…”

“…10 The treatment for Lucio's phenomenon comprises antileprosy antibiotics, often including rifampicin, corticosteroids to control the massive immune reaction to M leprae antigens, and sometimes thalidomide and clofazimine. 7 Despite aggressive management, mortality has been reported. Mortality is most commonly associated with superimposed infection and subsequent sepsis because of the presence of a compromised skin barrier, poor overall nutritional status, and delay in diagnosis or misdiagnosis.…”

“…5 However, fulminant superinfection of the upper extremity in the setting of leprosy has rarely been described in the literature. 7 In our report, we present a rare case of upper extremity NF secondary to previously undiagnosed and untreated lepromatous leprosy with Lucio phenomenon, and we discuss the pertinent diagnostic algorithm and management.…”