The online version of this article (doi:10.1186/1752-1947-8-229) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
AK, MRN, JY, and TK diagnosed the clinical scenario. MRN and AK researched and drafted the document. All authors provided care for the patient. All authors read and approved the final manuscript.
Necrotizing soft tissue infections can affect various tissue planes. Although predisposing etiologies are many, they mostly center on impaired immunity occurring directly or indirectly and loss of integrity of protective barriers which predispose to infection. The nonspecific presentation may delay diagnosis and favor high mortality.
Two case vignettes are presented. The first patient, a 44-year-old healthy South Asian man with a history of repeated minor traumatic injury presented to a primary health care center with a swollen left lower limb. He was treated with antibiotics with an initial diagnosis of cellulitis. Because he deteriorated rapidly and additionally developed intestinal obstruction, he was transferred to our hospital which is a tertiary health care center for further evaluation and management. Prompt clinical diagnosis of necrotizing soft tissue infection was made and confirmed on magnetic resonance imaging as necrotizing fasciitis. Urgent debridement was done, but the already spread infection resulted in rapid clinical deterioration with resultant mortality. The second patient was a 35-year-old South Asian woman with systemic lupus erythematous receiving immunosuppressive therapy who developed left lower limb pain and fever. Medical attention was sought late as she came to the hospital after 4 days. Her condition deteriorated rapidly as she developed septic shock and died within 2 days.
Necrotizing fasciitis can be fatal when not recognized and without early intervention. Clinicians and surgeons alike should have a greater level of suspicion and appreciation for this uncommon yet lethal infection.
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Davoudian P, Flint NJ: Necrotizing fasciitis. 2012, Critical Care & Pain: Continuing Education in Anaesthesia, doi:10.1093/bjaceaccp/mks033
Necrotizing Fasciitis. http://www.nycpm.edu/surgclub/necrotizing.pdf,
Roujeau JC: Necrotizing fasciitis. Clinical criteria and risk factors. Ann Dermatol Venereol. 2001, 128: 376-381. PubMed
Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO: Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003, 85-A: 1454-1460. PubMed
Clostridial myonecrosis. http://www.uptodate.com/contents/clostridial-myonecrosis,
Serinken M, Erdur B, Sener S, Kabay B, Cevik A: A Case of Mortal Necrotizing Fasciitis of the Trunk Resulting From a Centipede ( Scolopendra moritans) Bite. Internet J Emerg Med. 2004, 2 (2):
Necrotising fasciitis. http://www.dermnetnz.org/bacterial/necrotising-fasciitis.html,
Huang JW, Fang CT, Hung KY, Hsueh PR, Chang SC, Tsai TJ: Necrotizing fasciitis caused by Serratia marcescens in two patients receiving corticosteroid therapy. J Formos Med Assoc. 1999, 98: 851-854. PubMed
Nimesh KP, Laura M: A Rare Cause of Necrotizing Fasciitis in a Patient With Systemic Lupus Erythematosus. C56 PULMONARY AND NON-PULMONARY CRITICAL CARE: GREAT CASES!: American Thoracic Society: A4596: American Thoracic Society International Conference Abstracts.
Angoules AG, Kontakis G, Drakoulakis E, Vrentzos G, Granick MS, Giannoudis PV: Necrotising fasciitis of upper and lower limb: a systematic review. Injury. 2007, 38 (Suppl 5): S19-S26. PubMed
Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS: Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery. 1990, 108: 847-850. PubMed
Hassan Z, Mullins RF, Friedman BC, Shaver JR, Brandigi C, Alam B, Mian MA: Treating necrotizing fasciitis with or without hyperbaric oxygen therapy. Undersea Hyperb Med. 2010, 37: 115-123. PubMed
Bretzke ML, Bubrick MP, Hitchcock CR: Diffuse spreading Clostridium septicum infection, malignant disease and immune suppression. Surg Gynecol Obstet. 1988, 166: 197-199. PubMed
Taviloglu K, Cabioglu N, Cagatay A, Yanar H, Ertekin C, Baspinar I, Ozsut H, Guloglu R: Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg. 2005, 71: 315-320. PubMed
Management of intra-abdominal abscesses. http://www.ncbi.nlm.nih.gov/books/NBK6937/,
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