scholarly journals Bowel perforation presenting as necrotizing soft-tissue infection of thigh a rare presentation

2020 ◽  
Vol 7 (12) ◽  
pp. 4206
Author(s):  
Navdeep Garg ◽  
Kunal Singla ◽  
Maninder Singh ◽  
Mandeep Singh ◽  
Rajesh Kumar Bansiwal ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bowel Perforation ◽  
Radiographic Finding ◽  
Underlying Disease ◽  
Rare Presentation ◽  
Cutaneous Manifestations ◽  
Mortality And Morbidity ◽  
Fournier Gangrene ◽  
Necrotizing Soft Tissue Infections ◽  
Delayed Recognition

Necrotizing soft-tissue infections (NSTI) are characterized by extensive and rapidly progressing soft tissue inflammation with necrosis. It typically involves a gas-forming bacterium such as group A b-hemolytic Streptococcus or a Clostridium species. This gas formation leads to the radiographic finding of subcutaneous emphysema. It is recognized as a surgical emergency. NSTI of the abdominal wall, flank, or thigh resulting from break-in bowel integrity is an atypical presentation that may cause delayed recognition and treatment, resulting in a mortality rate greater than that in Fournier gangrene. Early detection and aggressive surgical debridement are crucial to reduce patient mortality and morbidity. We present the case of a 30-year-old patient presenting with fasciitis of lower limb. Surgical exploration revealed the source of the emphysema to be an entero-cutaneous fistula. The patient had an unstable and prolonged hospitalization after debridement of the thigh and abdominal surgery and was discharged after one month. It suggested that clinical presentation can be highly variable and range from early sepsis with obvious skin involvement to minimal cutaneous manifestations of underlying disease.

scholarly journals Necrotizing Soft-Tissue Infection: Laboratory Risk Indicator for Necrotizing Soft Tissue Infections Score

2014 ◽  
Vol 6 (01) ◽  
pp. 046-049 ◽  
Author(s):  
Madhuri Kulkarni ◽  
Vijay Kumar GS ◽  
Sowmya GS ◽  
Madhu CP ◽  
Ramya SR
Keyword(s):  
Soft Tissue ◽  
Immunocompromised Host ◽  
High Morbidity ◽  
Risk Indicator ◽  
Soft Tissue Infections ◽  
Acinetobacter Species ◽  
Mortality And Morbidity ◽  
Necrotizing Soft Tissue Infections ◽  
Lrinec Score ◽  
Immunocompromised Hosts

ABSTRACTNecrotizing soft tissue infections (NSTI) can be rapidly progressive and polymicrobial in etiology. Establishing the element of necrotizing infection poses a clinical challenge. A 64-year-old diabetic patient presented to our hospital with a gangrenous patch on anterior abdominal wall, which progressed to an extensive necrotizing lesion within 1 week. Successive laboratory risk indicator for necrotizing softtissue infections (LRINEC) scores confirmed the necrotizing element. Cultures yielded Enterococci, Acinetobacter species and Apophysomyces elegans and the latter being considered as an emerging agent of Zygomycosis in immunocompromised hosts. Patient was managed with antibiotics, antifungal treatment and surgical debridement despite which he succumbed to the infection. NSTI’s require an early and aggressive management and LRINEC score can be applied to establish the element of necrotizing pathology. Isolation of multiple organisms becomes confusing to establish the etiological role. Apophysomyces elegans, which was isolated in our patient is being increasingly reported in cases of necrotizing infections and may be responsible for high morbidity and mortality. This scoring has been proposed as an adjunct tool to Microbiological diagnosis when NSTI’s need to be diagnosed early and managed promptly to decrease mortality and morbidity, which however may not come in handy in an immunocompromised host with polymicrobial aggressive infection.

scholarly journals Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study

2021 ◽  
Author(s):  
Sébastien Tanaka ◽  
Michael Thy ◽  
Parvine Tashk ◽  
Lara Ribeiro ◽  
Brice Lortat-Jacob ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Underlying Disease ◽  
Exposed Group ◽  
Source Control ◽  
Suspected Sepsis ◽  
Unexposed Group ◽  
Lengths Of Stay ◽  
Necrotizing Soft Tissue Infections

Abstract Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.

Hyperbaric oxygen therapy as an adjuvant to source control in necrotizing soft tissue infections

2017 ◽  
Vol 44 (6) ◽  
pp. 535-542
Author(s):  
António Pedro Pinto Ferreira ◽  
◽  
Sérgio Santos Vide ◽  
Tiago David Fonseca Fernandes ◽  
Pedro Miguel Barata de Silva Coelho ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Source Control ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections

Effect of transfer status on outcomes for necrotizing soft tissue infections

2017 ◽  
Vol 220 ◽  
pp. 372-378 ◽  
Author(s):  
Angela M. Ingraham ◽  
Hee Soo Jung ◽  
Amy E. Liepert ◽  
Charles Warner-Hillard ◽  
Caprice C. Greenberg ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections

scholarly journals Multiple Koenen Tumors, a Rare Entity: Combination Treatment with 1% Topical Sirolimus Electrofulguration and Excision

2020 ◽  
Vol 7 (1) ◽  
pp. 66-70
Author(s):  
Vishalakshi Viswanath ◽  
Jay D. Gupte ◽  
Niharika Prabhu ◽  
Nilima L. Gour
Keyword(s):  
Tuberous Sclerosis ◽  
Combination Treatment ◽  
Tumor Regression ◽  
Surgical Excision ◽  
Tumor Formation ◽  
Rare Entity ◽  
Rare Presentation ◽  
Cutaneous Manifestations ◽  
Elderly Female

<b><i>Introduction:</i></b> Koenen tumors are benign, cutaneous manifestations of tuberous sclerosis. These are disfiguring, painful, and challenging to treat as they frequently recur. We report a case of long-standing, multiple Koenen tumors affecting all twenty nails in an elderly female who was successfully treated with a combination of topical sirolimus 1%, surgical excision, and electrofulguration. <b><i>Case Report:</i></b> A 57-year-old lady presented with multiple, asymptomatic periungual, and subungual tumors affecting all twenty nails since 27 years. Cutaneous examination revealed confetti macules, ash-leaf macule, and shagreen patch over trunk. Nail biopsy was compatible with Koenen’s tumor. Computerized tomography of brain showed diffuse patchy sclerosis. The tumors were treated with topical sirolimus 1% ointment for 10 months with excellent regression. Electro­fulguration for both great toenails and surgical excision of right thumbnail periungual fibroma was done. 1% sirolimus was advised after the surgical treatment. There were no adverse effects or recurrence of tumors over a 2-year follow-up. <b><i>Discussion:</i></b> Topical sirolimus 1% was effective in tumor regression and preventing new tumor formation. Larger tumors that interfered in daily chores were treated with excision and electrofulguration. Thus, a combination treatment for this rare presentation of tuberous sclerosis provided optimum results.

A rare solitary breast cancer metastasis to the soft tissue of the ipsilateral arm detected by a physiotherapist: A case report

2021 ◽  
Vol 41 (2) ◽  
pp. 187-191
Author(s):  
Ramesh Omranipour ◽  
Sadaf Alipour ◽  
Bita Eslami
Keyword(s):  
Breast Cancer ◽  
Soft Tissue ◽  
Cancer Metastasis ◽  
Multidisciplinary Treatment ◽  
Breast Cancer Metastasis ◽  
Frequency Interval ◽  
Treatment Team ◽  
Breast Cancer Patients ◽  
Rare Presentation ◽  
Adequate Treatment

BACKGROUND: Late occurrence of solitary soft tissue upper extremity metastasis of breast cancer is very rare. We hereby present a case of metastasis to the biceps muscle of the ipsilateral arm, detected by a physiotherapist six years after mastectomy. The aim of this report is to highlight the rarity of this presentation, to emphasize the role of the physiotherapist as a member of the multidisciplinary treatment team and the possibility of curative treatment despite the poor prognosis. CASE DESCRIPTION: A 2 * 3 cm well-defined isolated metastasis of breast cancer was diagnosed in the left arm of a 31-year-old woman 6 years after successful treatment of her primary tumor. Tumor characteristics, diagnostic plan, and treatment options are discussed. CONCLUSION: Due to its scarcity, there is a lack of knowledge about the frequency, interval, characteristics, best diagnostic modality, adequate treatment, and prognosis of isolated breast cancer metastasis to the soft tissue, and these can be found out by proper reporting. As an important member of the multidisciplinary team in the care and treatment of breast cancer patients, physiotherapists should be aware of this type of rare presentation.

Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality

2009 ◽  
Vol 8 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Javier Aragón-Sánchez ◽  
Yurena Quintana-Marrero ◽  
Jose L. Lázaro-Martínez ◽  
Maria J. Hernández-Herrero ◽  
Esther García-Morales ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Limb Loss ◽  
Soft Tissue Infections ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Necrotizing Soft Tissue Infections ◽  
Diabetes Outcome
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