Necrotising fasciitis: a narrative review of the literature

2021 ◽  
pp. 1-9
Author(s):  
Josiah Damisa ◽  
Sohail Ahmed ◽  
Sanjay Harrison
Keyword(s):  
Clinical Signs ◽  
Clinical Suspicion ◽  
Necrotising Fasciitis ◽  
Body Region ◽  
Risk Indicator ◽  
Review Of The Literature ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
Systemic Symptoms ◽  
The Uk

Necrotising fasciitis is a severe, life-threatening and rapidly progressive soft tissue infection that often requires aggressive surgical management, with an estimated incidence of about 0.24–0.40 per 100 000 in the UK. Necrotising fasciitis can be classified based on its microbiology or the anatomy or body region affected. Initial signs of necrotising fasciitis can be minimal and non-specific but a patient often presents with pain out of proportion to clinical signs on examination, as well as erythema and oedema, in addition to systemic symptoms associated with sepsis. Diagnosis is often based on high clinical suspicion with biochemical and clinical imaging used as adjuncts. To aid with early diagnosis of necrotising fasciitis, a scoring system known as the Laboratory Risk Indicator for necrotising fasciitis was developed which has a positive predictive value of 92%. Once diagnosed, appropriate resuscitation and antibiotics, along with prompt and aggressive surgical debridement, is the mainstay of treatment.

scholarly journals Giant dermoid cyst mimicking posterior fossa tumors in a child: A Case Report and Review of the Literature

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e452020
Author(s):  
Leopoldo Mandic Ferreira Furtado ◽  
José Aloysio da Costa Val Filho ◽  
Bruno Lacerda Sandes ◽  
Plínio Duarte Mendes ◽  
Patrícia Salomé Gouvea Braga
Keyword(s):  
Case Report ◽  
Dermoid Cyst ◽  
Clinical Suspicion ◽  
Review Of The Literature ◽  
Benign Lesions ◽  
Posterior Fossa Tumors ◽  
Case Presentation ◽  
High Clinical Suspicion ◽  
Neuroimaging Data ◽  
Epidemiological Characteristics

Introduction: Intracranial dermoid cysts are rare, congenital and, benign lesions. The etiology of these lesions is related to an embryonic defect during neurulation. Case presentation: The present study describes a case of a 3-year-old girl with a giant cerebellar dermoid cyst, which initially manifested as hydrocephalus. Discussion: We discuss its epidemiological characteristics as well as diagnostic and therapeutic management. The combination of high clinical suspicion, anamnesis, thorough physical examination, and adequate interpretation of neuroimaging data is crucial for the early diagnosis and timely therapeutic intervention for such cysts. Conclusion: Surgical approach involving complete lesion resection considerably improves prognosis.

scholarly journals DRESS Syndrome in a Teenage Male Associated With Hhv-6 Reactivation While on Prolonged TMP-SMX Use

2021 ◽  
Author(s):  
Dalia Conteras ◽  
Iris Pecson ◽  
Alvaro Galvis
Keyword(s):  
Drug Reaction ◽  
Healthcare Providers ◽  
Delay In Diagnosis ◽  
High Clinical Suspicion ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms ◽  
Disseminated Disease ◽  
Systemic Drug

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare and potentially life-threatening systemic drug reaction with skin involvement. We present the unusual case of DRESS in a 16-year-old male that was treated with TMP-SMX for acne and was initially misdiagnosed with Steven Johnson Syndrome. Our case serves as an example to healthcare providers treating adverse drug reactions to having a high clinical suspicion for DRESS as delay in diagnosis and treatment can result in disseminated disease and higher patient mortality risk.

Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

2021 ◽  
Vol 14 (7) ◽  
pp. e243412
Author(s):  
Chee Chean Lim ◽  
Jeyasakthy Saniasiaya ◽  
Jeyanthi Kulasegarah
Keyword(s):  
Infectious Disease ◽  
Rare Case ◽  
Clinical Suspicion ◽  
Near Miss ◽  
Emergency Setting ◽  
History Taking ◽  
Suppurative Otitis Media ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
History Of

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

scholarly journals Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Federico Coccolini ◽  
Mario Improta ◽  
Edoardo Picetti ◽  
Luigi Branca Vergano ◽  
Fausto Catena ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Clinical Signs ◽  
The Body ◽  
Body Region ◽  
Many Body ◽  
Patient Death ◽  
Body Regions ◽  
Time Burden ◽  
Life Threatening

AbstractCompartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions. Surgical intervention to decompress affected organs or area of the body is often the only effective treatment, although evidences to assess the best timing of intervention are lacking. Present paper systematically reviewed the literature stratifying timings according to the compartmental syndromes which may beneficiate from immediate, early, delayed, or prophylactic surgical decompression. Timing of decompression have been stratified into four categories: (1) immediate decompression for those compartmental syndromes whose missed therapy would rapidly lead to patient death or extreme disability, (2) early decompression with the time burden of 3–12 h and in any case before clinical signs of irreversible deterioration, (3) delayed decompression identified with decompression performed after 12 h or after signs of clinical deterioration has occurred, and (4) prophylactic decompression in those situations where high incidence of compartment syndrome is expected after a specific causative event.

scholarly journals DRESS Syndrome due to Nevirapine Treated with Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Henrique Pott Junior ◽  
Gisele Cristina Gosuen ◽  
Ana Cristina Gales
Keyword(s):  
Clinical Presentation ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Clinical Suspicion ◽  
Significant Morbidity ◽  
Dress Syndrome ◽  
Infected Female ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Nevirapine-induced DRESS syndrome is uncommon but a potentially life-threatening condition, with significant morbidity and mortality rates due to multiple-organ involvement. The authors report a case of a 47-year-old HIV-infected female patient who presented with fever, right hypochondrium pain, jaundice, and skin rash. The Nevirapine-induced DRESS syndrome was suspected based on clinical presentation and RegiSCAR scoring system. This case highlights the need for a high index of clinical suspicion among HIV-infected patients with severe skin eruption and systemic symptoms.

scholarly journals Ceftriaxone Induced Toxic Epidermal Necrolysis

JMS SKIMS ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 51-53
Author(s):  
Surjeet Singh ◽  
Munir Wani ◽  
Altaf Rasool
Keyword(s):  
Inguinal Hernia ◽  
Mortality Rate ◽  
Toxic Epidermal Necrolysis ◽  
Treatment Guidelines ◽  
Postoperative Management ◽  
Clinical Suspicion ◽  
Bilateral Inguinal Hernia ◽  
Case Presentation ◽  
High Clinical Suspicion ◽  
Life Threatening

Introduction: toxic epidermal necrolysis is a life-threatening exfoliative disorder with a high mortality rate Case presentation: we present a 65-year-old Kashmiri male patient who was admitted for recurrent bilateral inguinal hernia, and developed ceftriaxone induced toxic epidermal necrolysis during postoperative period when he was administered antibiotics during postoperative management. Conclusion: toxic epidermal necrolysis is an exfoliative disorder which is mostly fatal. High clinical suspicion, prompt recognition, immediate withdrawal of suspected agent and initiation of supportive care are mandatory for these patients, where optimal treatment guidelines are still unavailable. JMS 2018;21(1):51-53

scholarly journals Acute respiratory failure in an infant and thiamine deficiency in West Africa: a case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
L Hiffler ◽  
K Escajadillo ◽  
M Rocaspana ◽  
S Janet
Keyword(s):  
Case Report ◽  
Respiratory Failure ◽  
Thiamine Deficiency ◽  
Severe Pneumonia ◽  
West African ◽  
Clinical Suspicion ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
Diagnostic Capacity ◽  
Low Threshold

Abstract In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize, because it mimics or can be confused with other diseases even in cases of classic beriberi. Unsurprisingly, the likelihood of misdiagnosis of TD is even greater where beriberi has not been described. Critically ill patients have increased thiamine body consumption and dextrose-based IV fluid increases thiamine cellular demand even further. Consequently, severe acute conditions may result in TD, or trigger TD signs in patients with borderline thiamine status, with life-threatening consequences. Here, we describe the case of a young patient admitted to a West African hospital where TD is not well documented and diagnosed with severe pneumonia who responded dramatically to thiamine injection. The lack of rapid diagnostic capacity and the severe outcome of TD justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about TD and low threshold for thiamine use should guide clinicians in their practice.

scholarly journals A five-year review of necrotising fasciitis in a tertiary referral unit

2013 ◽  
Vol 95 (1) ◽  
pp. 57-60 ◽  
Author(s):  
RA Swain ◽  
JC Hatcher ◽  
BS Azadian ◽  
N Soni ◽  
B De Souza
Keyword(s):  
Scoring System ◽  
Group A Streptococcus ◽  
Case Series ◽  
Necrotising Fasciitis ◽  
Risk Indicator ◽  
Tertiary Referral ◽  
Life Threatening Illness ◽  
Life Threatening ◽  
Group A ◽  
Spread Of Infection

Introduction Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system. Methods A retrospective analysis of patient notes over the five-year period from October 2006 to October 2011 was undertaken. The LRINEC score was calculated for each patient to evaluate its usefulness. Results Overall, 15 patients were diagnosed with necrotising fasciitis. Three patients died. The median age of patients was 51.0 years (range: 34–76 years). There were no obvious predisposing factors in 8 cases but patients had a median of 2.0 co-morbidities. The most common infective agent, present in five patients, was Group A Streptococcus. Other monomicrobial agents included Group G Streptococcus and Klebsiella pneumoniae. Polymicrobial infections were less common than monomicrobial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. Although the LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified as low likelihood. Conclusions This limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis.

Migrating fish bone presenting as a neck fistula

2021 ◽  
Vol 14 (7) ◽  
pp. e243622
Author(s):  
Sara Fernandes Custódio ◽  
Pedro Branco ◽  
Pedro Machado Sousa ◽  
Pedro Alberto Escada
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Fish Bone ◽  
Clinical Suspicion ◽  
Aerodigestive Tract ◽  
Upper Aerodigestive Tract ◽  
Rare Finding ◽  
High Clinical Suspicion ◽  
Life Threatening

The case report describes an extremely rare finding of fish bone migration from the aerodigestive tract causing a neck fistula 2 years after its ingestion. Detailed case study and surgical treatment is presented. This case highlights the need for further assessment in presence of a high clinical suspicion of foreign body ingestion with a normal physical examination of the upper aerodigestive tract, to avoid serious and potential life-threatening complications later on.

scholarly journals Lucio’s phenomenon: A report of two cases and review of the literature

2019 ◽  
Vol 6 (2) ◽  
pp. 15 ◽  
Author(s):  
Gustavo Alexis Lemus-Barrios ◽  
Julian Andrés Hoyos-Pulgarín ◽  
Carlos Eduardo Jimenez-Canizales ◽  
Diana Melisa Hidalgo-Zambrano ◽  
Fredy Escobar-Montealegre ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Mycobacterium Leprae ◽  
Clinical Suspicion ◽  
World Health ◽  
Necrotizing Vasculitis ◽  
Review Of The Literature ◽  
Peripheral Nerve Damage ◽  
High Clinical Suspicion ◽  
Health Organization ◽  
Lucio’S Phenomenon

Introduction: Leprosy is a chronic, multisystemic granulomatous infection caused by Mycobacterium leprae. Lucio’s phenomenon is an uncommon reaction consisting of a severe chronic necrotizing vasculitis. The purpose of this article is to present two cases of Lucio’s phenomenon and a review of the literature on its clinical presentation and management.Case Presentation: Two middle-aged men presented with ulcers and ecchymosis in lower extremities, with simultaneous peripheral nerve damage and leonine facies. Both were treated according to World Health Organization recommendations, with a favorable clinical response.Discussion: The clinical characteristics presented in this article make part of the classical description. A proper history and physical examination allowed for a correct diagnostic approach and prompt confirmation of diagnosis, despite the unspecific nature of these signs and symptoms.Conclusions: Leprosy and Lucio’s phenomenon are infrequent conditions that are difficult to diagnose. We suspect this condition to be under-registered. Awareness and a high clinical suspicion are necessary in endemic regions.

Sign in / Sign up

Export Citation Format

Share Document