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Subacute necrotizing fasciitis caused by gas-producing Staphylococcus aureus
W R Saliba1, L H Goldstein, R Raz
1Department of Internal Medicine C, Ha-Emeq Medical Center, Afula 18101, Israel. salibuss@yahoo.com
Summary
Necrotizing fasciitis developed in a diabetic woman after insulin injection. Staphylococcus aureus caused this rare, slow-progressing soft-tissue infection, requiring extensive surgery for recovery.
Area of Science:
- Infectious Diseases
- Dermatology
- Endocrinology
Background:
- Necrotizing fasciitis is a severe bacterial infection of the fascia and subcutaneous tissue.
- Diabetes mellitus is a known risk factor for various infections, including skin and soft-tissue infections.
- Subcutaneous insulin injections are common in diabetic patients, creating potential inoculation sites.
Observation:
- A 54-year-old diabetic woman presented with bilateral thigh necrotizing fasciitis following subcutaneous insulin injection.
- Initial symptoms included severe localized pain, followed by the appearance of soft-tissue gas.
- Staphylococcus aureus was the sole pathogen identified via incisional biopsy on day 10.
Findings:
- The infection progressed slowly despite medical management.
- Surgical intervention, including fasciotomy, drainage, and debridement, was necessary for patient recovery 4 weeks post-admission.
- Staphylococcus aureus can cause a subacute form of necrotizing fasciitis, particularly in diabetic patients.
Implications:
- Physicians should consider Staphylococcus aureus in diabetic patients with soft-tissue infections exhibiting gas formation.
- Infection at insulin injection sites warrants vigilance for Staphylococcus aureus, especially in diabetics.
- Early recognition and aggressive surgical management are crucial for favorable outcomes in necrotizing fasciitis.