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A Nearly Missed Case of Severe Necrotizing Soft Tissue Infection
1Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, USA.
Abstract:
Necrotizing soft tissue infections (NSTIs) are deadly infections that can involve all tissue layers from the epidermis to the muscle. NSTIs can be difficult to diagnose, as skin manifestations are often absent early in the course of the disease, and they can be difficult to differentiate from simple cellulitis. Definitive diagnosis and treatment occur in the operating room. We present a case of a 65-year-old female who presented with lightheadedness and presyncope, with planned admission for an exacerbation of chronic obstructive pulmonary disease. Prior to admission, however, she was found to have an NSTI. The patient went to the operating room and had an extensive debridement followed by prolonged hospital stay. This case highlights the importance of a thorough physical examination in ill-appearing patients with non-specific symptoms, possible sepsis, and any alteration in mental status.
Insights
Necrotizing soft tissue infections (NSTIs) are severe, potentially fatal infections. Early diagnosis is crucial, as subtle symptoms can mimic less severe conditions, emphasizing the need for thorough physical exams in at-risk patients.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Critical Care Medicine
Background:
- Necrotizing soft tissue infections (NSTIs) are rapidly progressive, life-threatening infections affecting all tissue layers.
- Early diagnosis of NSTIs is challenging due to nonspecific symptoms and subtle skin manifestations, often mimicking cellulitis.
- Delayed diagnosis and treatment of NSTIs are associated with high morbidity and mortality.
