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Multifocal necrotizing fasciitis - case report
E Musialkowska1, M Jedynak, A Klepacki
1Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland. ewadylejko@yahoo.com
Purpose:
Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection, characterized by rapidly spreading inflammation, with secondary necrosis of the fascia and surrounding tissues. It is mostly caused by group A beta-haemolytic streptococci or multibacterial. A case of the 25-year-old man admitted on September 2006 to the Department of Dermatology and Venereology with suspicion of erysipelas of the left upper limb and left foot is presented. On admission the pain, erythema, diffuse oedema of the left upper limb and erythema of the left foot were observed. Laboratory results revealed elevated: ESR, acute phase parameters (C-reactive protein, D-dimer), CPK and fibrinogen. Within 72-hours, despite treatment with antibiotics and anticoagulants, the oedema and pain increased, initial necrosis of the skin and extreme local tenderness appeared. Suspecting NF the patient had been transported to the Department of Surgery from where, after surgical debridement of devitalized tissue, was moved to the Intensive Care Unit and then transferred to the National Centre of Hyperbaric Medicine of the Medical University of Gdansk. Despite of repeated debridement, aggressive antibiotic therapy and hyperbaric oxygen therapy, necrosis was spreading. The patient developed sepsis and acute respiratory distress syndrome. Amputation of the left upper limb was performed. Five months later patient was admitted to ICU in Bialystok after a suicide attempt. After next four months he died. The dramatic course of the disease is the evidence, that having an adequate knowledge about early symptoms of NF can save patient's life.
Insights
Necrotizing fasciitis (NF) is a severe infection causing rapid tissue death. Early recognition of its symptoms is crucial for potentially saving a patient's life, as demonstrated by a severe case requiring amputation.
Area of Science:
- Infectious Diseases
- Dermatology
- Surgery
Background:
- Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapid inflammation and tissue necrosis.
- It is often caused by Group A beta-hemolytic streptococci or a combination of bacteria.
Observation:
- A 25-year-old male presented with symptoms initially suspected as erysipelas, but rapidly progressed over 72 hours.
- Clinical signs included increasing pain, erythema, edema, skin necrosis, and extreme tenderness.
- Laboratory findings showed elevated ESR, C-reactive protein, D-dimer, CPK, and fibrinogen.
Findings:
- Despite aggressive treatment including antibiotics, anticoagulants, surgical debridement, and hyperbaric oxygen therapy, the necrosis continued to spread.
- The patient developed severe complications, including sepsis and acute respiratory distress syndrome, necessitating limb amputation.
Implications:
- This case underscores the critical importance of prompt diagnosis and intervention for necrotizing fasciitis.
- Awareness of early NF symptoms among healthcare professionals can significantly impact patient outcomes and potentially prevent devastating consequences.