Lower Limb Serratia marcescens Necrotizing Fasciitis Complicated by Nosocomial COVID-19

Area of Science:

• Infectious Diseases
• Surgery
• Critical Care Medicine

Background:

• Necrotizing fasciitis (NF) is a severe soft tissue infection with high mortality.
• Serratia marcescens is an uncommon pathogen causing NF, often associated with poor outcomes like amputation.
• Immunocompromised status, such as lupus nephritis, increases susceptibility to severe infections.

Observation:

• A 56-year-old immunocompromised male with lupus nephritis developed lower limb NF due to Serratia marcescens.
• The patient subsequently contracted nosocomial coronavirus disease 2019 (COVID-19) pneumonitis.
• A multidisciplinary team approach was crucial for managing this complex case.

Findings:

• Successful limb salvage was achieved despite the severe infection and subsequent COVID-19.
• The patient demonstrated functional recovery, ambulating independently at 11 months post-operatively.
• Literature review revealed a paucity of Serratia marcescens lower limb NF cases, with none previously reported in conjunction with COVID-19.

Implications:

• This case represents the first reported instance of lower limb Serratia marcescens NF complicated by COVID-19.
• Findings underscore the importance of a multidisciplinary approach in managing complex infectious disease scenarios.
• The study provides valuable insights for clinical management, particularly with COVID-19's endemic status impacting NF presentations and outcomes.