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Published on: March 14, 2025
Pasteurella multocida ecthyma complicated by necrotizing fasciitis
Nima Milani-Nejad1, Kelly Tyler, Carmine A Grieco
1Medical Scientist Training Program, Ohio State University Wexner Medical Center, Columbus, Ohio, Department of Internal Medicine, Division of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio. nima.milaninejad@osumc.edu.
Abstract:
Necrotizing fasciitis is a serious infection of the skin and soft tissues. Pasteurella multocida is rarely reported to cause necrotizing fasciitis and is associated with high mortality. We describe a female patient with a past medical history of diabetes mellitus and myeloproliferative disorder presenting with bullae and erythema of the right forearm secondary to P. multocida infection after possible cat bite. Despite adequate antibiotic coverage she developed necrotizing fasciitis diagnosed clinically and on diagnostic imaging. Patient was taken to the operating room emergently and underwent irrigation and debridement with subsequent split-skin graft. She recovered well after the surgeries and was discharge on intravenous antibiotics. At clinic follow-up, her wounds were healing well without any significant new symptoms.
Insights
Necrotizing fasciitis, a severe soft tissue infection, can rarely be caused by Pasteurella multocida. This case highlights a patient with diabetes and myeloproliferative disorder who developed this serious infection after a cat bite.
Area of Science:
- Infectious Diseases
- Dermatology
- Microbiology
Background:
- Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection.
- Pasteurella multocida is an uncommon pathogen implicated in severe skin and soft tissue infections, typically associated with animal bites.
- Patients with underlying conditions like diabetes mellitus and myeloproliferative disorders may be at increased risk for severe infections.
Observation:
- A female patient with a history of diabetes mellitus and myeloproliferative disorder presented with bullae and erythema on her right forearm.
- The patient's symptoms were attributed to Pasteurella multocida infection, potentially acquired from a cat bite.
- Clinical and diagnostic imaging confirmed the development of necrotizing fasciitis despite appropriate antibiotic therapy.
Findings:
- Early surgical intervention, including irrigation and debridement, was crucial for managing the necrotizing fasciitis.
- A split-skin graft was successfully employed for wound reconstruction.
- The patient demonstrated a positive clinical outcome with wound healing following surgical procedures and intravenous antibiotic treatment.
Implications:
- This case underscores the importance of considering Pasteurella multocida in the differential diagnosis of severe soft tissue infections, especially in patients with relevant exposure history.
- Prompt recognition and aggressive management, including surgical debridement and antibiotics, are critical for improving outcomes in necrotizing fasciitis.
- Further research may elucidate specific risk factors and optimal treatment strategies for Pasteurella multocida-induced necrotizing fasciitis.
