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The Subacute Necrotizing Fasciitis: The Forgotten form of this Life-threatening Infection. A Case Report
Jorge Tramallino1, Adelaide Wojda1, Houssein Farhat1
1Department of Orthopaedics and Traumatology, University Hospital of Charleroi, Charleroi, Belgium.
Introduction:
Necrotizing fasciitis (NF) is a life-threatening soft-tissue infection. While the fulminate form is well documented, the subacute NF is rarely reported. Failure to consider NF as a diagnosis during this indolent presentation can be detrimental to patients because the surgical aggressive debridement remains the key of the treatment.
Case Report:
We report a case of a 54-year-old man who developed a subacute NF. After an initial diagnosis of cellulitis, the patient failed to show improvement with antibiotic treatment; he was referred to our institution in view to benefit of a surgical management. The patient developed progressive systemic toxic symptoms and an emergency debridement was made 10 h after his admission. Our patient achieves to show improvement with antibiotic treatment, vacuum-assisted closure therapy, hyperbaric oxygen therapy, and reconstructive surgery. Complete recovery was observed after 2 months.
Conclusion:
NF is a surgical emergency. Early diagnosis is essential, it is often ambiguous and commonly misdiagnosed including the subacute form. There needs to be a high suspicion for NF even in patients presenting with cellulitis without systemic symptoms.
Insights
Subacute necrotizing fasciitis (NF) is a rare, indolent infection. High suspicion is crucial for early diagnosis and surgical debridement, even with cellulitis symptoms, to ensure effective treatment.
Area of Science:
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotizing fasciitis (NF) is a severe soft-tissue infection, with the subacute form being infrequently documented.
- Prompt surgical debridement is critical for managing NF, yet diagnosis can be challenging in indolent presentations.
Observation:
- A 54-year-old male presented with symptoms initially diagnosed as cellulitis, unresponsive to antibiotics.
- The patient developed systemic toxicity, prompting emergency surgical debridement 10 hours after admission.
Findings:
- The patient's subacute necrotizing fasciitis was successfully treated with antibiotics, vacuum-assisted closure, hyperbaric oxygen therapy, and reconstructive surgery.
- Complete recovery was achieved within two months.
Implications:
- This case underscores the importance of considering necrotizing fasciitis in patients with persistent or worsening cellulitis, even without overt systemic signs.
- Early and aggressive surgical intervention, alongside multimodal therapy, is vital for favorable outcomes in subacute NF.
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