Necrotizing fasciitis – a diagnostic dilemma: two case reports

Journal of Medical Case Reports

Aruna Kulatunga¹  Thambyaiah Kandeepan¹  Jevon Yudhishdran¹  Mitrakrishnan Rayno Navinan¹ 

[1] National Hospital of Sri Lanka, Regent Street, Colombo 10, Sri Lanka

关键词: Systemic lupus erythematosus;    Necrotizing soft tissue infections;    Necrotizing fasciitis;   

Others  :  812149
DOI  :  10.1186/1752-1947-8-229

 received in 2014-02-26, accepted in 2014-04-22,  发布年份 2014

【 摘 要 】

Introduction

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.

Case presentation

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.

Conclusions

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.

【 授权许可】

   
2014 Navinan et al.; licensee BioMed Central Ltd.

【 图 表 】

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