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Necrotizing Faciitis after shoulder mobilization and intra-articular infiltration with betametasone
Joana Bento-Rodrigues1, Fernando Judas, Jorge Pedrosa Rodrigues
1Department of Orthopaedics. Coimbra University Hospital. Coimbra. Portugal.. joanabentorodrigues@gmail.com.
Abstract:
Necrotizing Fasciitis is a rapidly progressive, potentially fatal infection of superficial fasciae and subcutaneous tissue, usually resulting from an inciting trauma to the skin. Medical literature refers few cases of necrotizing fasciitis related to intra-articular infiltrations, that often lead to patients death. This report describes the clinical events on a 55 year-old diabetic patient who developed upper extremity Necrotizing Fasciitis, 18 days after shoulder mobilization and intra-articular infiltration, due to Staphylococcus epidermidis. An early surgical debridement was performed and antibiotherapy was established, resulting in a successful outcome, despite the functional disability. We point out, through this case, the possibility of intra-articular injections of drugs causing Necrotizing Fasciitis, especially in risk patients.
Insights
Intra-articular injections, particularly in diabetic patients, can lead to Necrotizing Fasciitis (NF), a severe skin infection. Early surgical intervention and antibiotics are crucial for successful treatment of this rare complication.
Area of Science:
- Infectious Diseases
- Orthopedics
- Dermatology
Background:
- Necrotizing Fasciitis (NF) is a severe, rapidly progressing infection affecting superficial fascia and subcutaneous tissue.
- Cases of NF linked to intra-articular infiltrations are rare but frequently fatal.
- Diabetic patients represent a high-risk group for severe infections.
Observation:
- A 55-year-old diabetic patient developed upper extremity Necrotizing Fasciitis 18 days post-shoulder mobilization and intra-articular infiltration.
- The causative agent was identified as Staphylococcus epidermidis.
- The patient underwent early surgical debridement and antibiotic therapy.
Findings:
- The case highlights a rare but serious complication of intra-articular injections.
- Staphylococcus epidermidis was identified as the pathogen responsible for the Necrotizing Fasciitis.
- Prompt surgical intervention and appropriate antibiotherapy led to a successful outcome, despite residual functional disability.
Implications:
- Intra-articular injections, even for non-infectious indications, carry a risk of inducing Necrotizing Fasciitis.
- Physicians should maintain a high index of suspicion for NF in patients with risk factors (e.g., diabetes) presenting with signs of infection post-injection.
- Early diagnosis and aggressive management, including surgical debridement, are critical for improving outcomes in Necrotizing Fasciitis.