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[Necrotizing fasciitis following therapeutic injection in a shoulder joint]
F Unglaub1, T Guehring, P C Fuchs
1Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum Aachen. funglaub@ukaachen.de
Abstract:
Necrotizing fasciitis is an inflammatory, rapidly progressive soft tissue infection usually caused by Streptococcus pyogenes or by a combination of aerobic and anaerobic microorganisms. Here we report the case of a patient who developed necrotizing fasciitis near the site of therapeutic injections. An orthopaedic surgeon in private practice had given the 74-year-old patient, who suffered from left shoulder pain, cortisone injections in his left shoulder joint. During the course of this therapy, the patient developed necrotizing fasciitis. Despite radical surgical debridement of the patient's back, left thorax and amputation of his left arm, the patient expired 15 h after arriving at our department. In cases such as these, patient survival depends upon an early diagnosis followed by immediate radical surgical intervention including complete opening of fascial compartments and excision of necrotic tissues.
Insights
Necrotizing fasciitis, a severe soft tissue infection, can occur near therapeutic injection sites. Early diagnosis and radical surgery are critical for survival in these rapidly progressing cases.
Area of Science:
- Infectious Diseases
- Orthopaedic Surgery
- Pathology
Background:
- Necrotizing fasciitis is a severe, rapidly progressing soft tissue infection.
- Commonly caused by Streptococcus pyogenes or polymicrobial infections.
- Therapeutic injections, such as cortisone shots, are potential iatrogenic causes.
Observation:
- A 74-year-old patient developed necrotizing fasciitis near the site of cortisone injections in the left shoulder.
- The infection rapidly progressed, affecting the back, left thorax, and necessitating arm amputation.
Findings:
- Despite aggressive surgical intervention, including debridement and amputation, the patient expired 15 hours after admission.
- This case highlights a rare but devastating complication of therapeutic injections.
Implications:
- Emphasizes the critical need for prompt diagnosis of necrotizing fasciitis.
- Underscores the importance of immediate, radical surgical debridement and fasciotomy for patient survival.
- Suggests considering injection site infections in the differential diagnosis of rapidly progressing soft tissue infections.
