scholarly journals Fulminant necrotizing fasciitis to the hand in a patient on high-dose steroids: A case report of successful limb salvage

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Miguel Johnson ◽  
Juan Berner ◽  
George Christopoulos ◽  
Preci Hamilton ◽  
Robert Pearl
Keyword(s):  
Case Report ◽  
Early Detection ◽  
Necrotizing Fasciitis ◽  
Limb Salvage ◽  
Vasogenic Edema ◽  
High Dose ◽  
Steroid Use ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Early Features

Abstract Glucocorticoids are commonly used in the management of patients with brain Tumour for reducing peritumoral and vasogenic edema. However, they may lead to development of limb and life-threatening conditions such as necrotizing fasciitis (NF). NF is a rare but potentially lethal condition. Early detection and aggressive treatment may lead to decreased mortality and limb salvage. The diagnosis is predominately clinical but may be supported by laboratory and radiological investigations. Chronic steroid use not only predisposes to the development of NF but also may mask early features delaying presentation and diagnosis. Clinicians should have a high index of suspicion especially in patients on chronic steroid therapy as this may aid in early detection and treatment. We present a case report of a successful limb salvage that exemplifies these points.

Necrotizing Fasciitis Occurred in the Lymphedematous leg

2021 ◽  
pp. 153473462110230
Author(s):  
Hisako Hara ◽  
Makoto Mihara ◽  
Takeshi Todokoro
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Lower Limb ◽  
Gynecologic Cancer ◽  
Vital Signs ◽  
Ethics Committee ◽  
Secondary Lymphedema ◽  
Delayed Treatment ◽  
Institutional Ethics ◽  
Life Threatening

Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.

scholarly journals Necrotizing fasciitis with prior leprosy: a case report

2020 ◽  
Vol 6 (6) ◽  
pp. 788
Author(s):  
Vannia C. Teng ◽  
Prima K. Esti ◽  
Sweety Pribadi
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Limited Resource ◽  
Masking Effect ◽  
Risk Indicator ◽  
Broad Spectrum Antibiotic ◽  
Life Threatening ◽  
Lrinec Score ◽  
Improve Patient Management ◽  
Improve Patient

<p class="abstract">Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with a high misdiagnosis rate. Here, we present the case of NF with hypoesthesia due to prior leprosy in a limited resource area. Laboratory risk indicator for NF (LRINEC) score was used to determine the diagnosis of NF. Resuscitation and broad-spectrum antibiotic were initiated, followed by surgical debridement due to lack of wound improvement and skin graft to cover the wound was done. This case report highlights the usage of LRINEC score to reduce misdiagnosis, ensure early diagnosis, and improve patient management in NF with masking effect.</p>

scholarly journals Dieulafoy Lesion of Ileum: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 64-66
Author(s):  
Prakash Poudel ◽  
Ramesh Dhakwa
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Gastrointestinal Haemorrhage ◽  
Definitive Diagnosis ◽  
Gi Bleeding ◽  
Mucosal Defect ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Dieulafoy Lesion

Dieulafoy lesion is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). A 31 yearold male presented with complaints of hematochezia. Preliminary investigations failed to locate the exact source of bleed. Enteroscopy suggested distal ileal bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.5 cm was identified in distal ileum. 30 cm of ileum along with mesentery was resected. Histology revealed it to be Dieulafoy lesion. Dieulafoy lesion is uncommon but one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. This lesion is difficult to identify and high index of suspicion is required to make diagnosis. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.

Limb Salvage in a Diabetic with Necrotizing Fasciitis: Case Report and Literature Review

Foot & Ankle ◽  
1986 ◽  
Vol 6 (4) ◽  
pp. 199-207
Author(s):  
Steven B. Carlow ◽  
Richard L. Jacobs ◽  
Danica K. Vedder
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Early Diagnosis ◽  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Limb Salvage ◽  
Clinical Signs ◽  
Tissue Biopsy ◽  
Functional Limb

Necrotizing fasciitis must be considered in a diabetic with cutaneous ulceration. A case report of limb salvage in a 48-year-old diabetic female with progressive necrotizing fasciitis is presented. Methods of early diagnosis including clinical signs, radiographs, and soft tissue biopsy of the involved extremity are reviewed. The microbiology of the disease is also discussed. A modification of the Orr technique using infrequent dressing changes in the management of necrotizing fasciitis is presented. In our case this resulted in preservation of life and a functional limb.

scholarly journals Case Report of Necrotizing Fasciitis Associated withStreptococcus pneumoniae

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Lei Jiao ◽  
Zain Chagla ◽  
Reham Mohammedsaeed Kaki ◽  
Gabriela Gohla ◽  
Marek Smieja
Keyword(s):  
Case Report ◽  
Streptococcus Pneumoniae ◽  
Necrotizing Fasciitis ◽  
Neutrophil Infiltration ◽  
Skin Lesions ◽  
Blood Samples ◽  
Surgical Exploration ◽  
Lower Back ◽  
Life Threatening ◽  
The Right

Necrotizing fasciitis, caused byStreptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated withStreptococcus pneumoniaeinfection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive forStreptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting fromStreptococcus pneumoniaediagnosed at early phase; the patient recovered well without surgical debridement.

scholarly journals Dentures that keeps airway patent: a case report

2020 ◽  
Vol 6 (2) ◽  
pp. 394
Author(s):  
Siti F. A. Razak ◽  
Stacy A. Jamarun ◽  
Siti H. Sanudin
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Foreign Body Aspiration ◽  
Main Complaint ◽  
Vehicle Accident ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

<p class="abstract">Foreign body aspiration is a life-threatening condition that requires immediate attention and intervention. Foreign body aspiration in adults usually occurs during dental procedure or motor vehicle trauma. Classical symptoms include choking, cough, haemoptysis, hoarseness or stridor. This case report presents an incident of a foreign body lodged at the subglottic region in an adult wearing dental prosthesis; the main complaint was hoarseness post motor vehicle accident. High index of suspicion coupled with correct investigation will facilitate the diagnosis of a foreign body in the airway thus immediate intervention can be taken to prevent morbidity and mortality.</p>

scholarly journals Case report of a submandibular abscess lethally tracking down through the mediastinum presenting as cardiac empyema

2020 ◽  
pp. 01-05
Author(s):  
Omar Y ◽  
Ali R ◽  
Anas M ◽  
Layal R
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Inflammatory Markers ◽  
Pericardial Tamponade ◽  
Shortness Of Breath ◽  
Mediastinal Abscess ◽  
Urgent Surgery ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Descending Mediastinitis

A 46-year-old male presented to our emergency with sudden severe shortness of breath and was found to have massive pericardial effusion causing cardiac tamponade and atrial fibrillation. He had to undergo immediate pericardiocentesis to relieve his symptoms and it drained frank pus indicating pericardial empyema as the underline cause of tamponade. On physical examination, patient was found to have a left submandibular tender swelling. He had increased inflammatory markers and on further imaging the CT showed massive diffuse mediastinal abscess. The patient had to undergo urgent surgery by multiple specialist surgeons in which large amount of pus was drained from the submandibular and mediastinum resulting in improvement of his condition and speeded his recovery. Key Messages • Thorough history and examination are of utmost importance. • Immediate treatment of pericardial tamponade is lifesaving. • High index of suspicion of descending mediastinitis should arise whenever purulent pericardial drainage is encountered. • Early diagnosis of mediastinal abscess by doing early radiographic investigations reduce mortality. • Head and neck abscesses must be treated properly to prevent life-threatening conditions.

scholarly journals Short course of high-dose steroids for anaphylaxis caused flare up of tuberculosis: A case report

2019 ◽  
Vol 7 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Shital Patil ◽  
Anil Jadhav
Keyword(s):  
Latent Tuberculosis ◽  
Community Acquired Pneumonia ◽  
High Dose ◽  
Bee Sting ◽  
Short Course ◽  
Life Threatening ◽  
Acute Form ◽  
Adequate Evaluation ◽  
Intravenous Steroids ◽  
High Index Of Suspicion

Abstract A 25-year-old male patient received high-dose intravenous steroids for life-threatening anaphylaxis because of bee sting only for 4 days resulted in reactivation of latent tuberculosis infection (LTBI). Clinical presentation is acute form of progressive pulmonary tuberculosis with pleural efusion that can be misdiagnosed as a community-acquired pneumonia. High index of suspicion with adequate evaluation is must in all cases to have satisfactory treatment outcome. Bronchoscopy is crucial in evaluation with histopathology expertise is must while managing such cases.

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