“Synchronous” Multifocal Necrotizing Fasciitis

Tocco, Ilaria; Lancerotto, Luca; Pontini, Alex; Voltan, Anna; Azzena, Bruno

doi:10.1016/j.jemermed.2013.05.064

Cited by 11 publications

(15 citation statements)

References 26 publications

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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. The most likely aetiology in this case based on the CT findings is perforated ischaemic colitis, which leads to metastatic spread of gas forming organisms throughout the portal and systemic circulation.…”

Section: Discussionmentioning

confidence: 60%

Multifocal necrotising fasciitis: a rarer presentation of a rare disease

2014

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Section: Discussionmentioning

confidence: 60%

Multifocal necrotising fasciitis: a rarer presentation of a rare disease

2014

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“…The literature suggests 5%-34% of NSTI cases have synchronous, multifocal involvement. Compared with patients with single sites of infection, those with multi-focal NSTI have higher inhospital mortality, with rates up to 67% reported [3][4][5], likely caused by delays in diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Multi-focal involvement of non-contiguous sites is even more rare but has been published in multiple case series and individual reports [3][4][5]. Retrospective analyses indicate that multifocal NSTIs have a higher mortality rate than infections of a single site [1].…”

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confidence: 99%

Fatal Multi-Focal Necrotizing Soft Tissue Infection in an Immunocompromised Patient

ShekaAdam

LoorMichele

2017

Surgical Infections Case Reports

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Background: Necrotizing soft tissue infection (NSTI) is an uncommon but devastating disease process. Multifocal NSTI is even more rare. Atypical presentations of NSTI delay definitive treatment with aggressive surgical debridement. Case Presentation: A 26-year-old Asian female who had undergone recent chemotherapy presented to the emergency department with vaginal bleeding. She was admitted for observation and developed rapidly progressive bilateral leg pain and ecchymosis. After the development of crepitus, the surgery team was consulted. Because of high suspicion for NSTI, she was taken to the operating room for surgical debridement. She was found to have extensive myonecrosis in her bilateral lower extremities necessitating amputations of both legs. Her left forearm was also explored, with all three extremities found to harbor gram-positive bacilli. Despite aggressive debridement and maximal intensive cares, the patient died on her first post-operative day because of Clostridium perfringens sepsis. Conclusion: Providers who care for immunocompromised patients must have a lower threshold to consider NSTI in their differential diagnosis. Immunocompromised patients may present in an atypical fashion, which delays diagnosis and treatment.

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“…Both the fascia and the deep dermis often show infiltration of polymorphonuclear cells. If bacteria are present in large numbers, they can often be seen in the H&E staining [ 20 , 28 ]. In macroscopically obvious cases of necrotic fascia, histology will only demonstrate non-specific necrosis and is not indicated.…”

Section: Methodsmentioning

confidence: 99%

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

et al. 2016

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BackgroundNecrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct.MethodsRetrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented.ResultsIn total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitisConclusionIn the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.

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“Synchronous” Multifocal Necrotizing Fasciitis

Cited by 11 publications

References 26 publications

Multifocal necrotising fasciitis: a rarer presentation of a rare disease

Multifocal necrotising fasciitis: a rarer presentation of a rare disease

Fatal Multi-Focal Necrotizing Soft Tissue Infection in an Immunocompromised Patient

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

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