Necrotizing Fasciitis: a Clinical Case and a Review of the Literature

Abstract Necrotizing fasciitis is a soft tissue, life-threatening infection with a fulminant and often fatal course. Early diagnosis is usually delayed as the onset of the disease is often masked in the form of erysipelas or cellulite. The condition is characterized by necrosis of the skin, subcutaneous tissue and underlying fascia. We describe a case of a 42-year-old man with a complaint of erythema, fever and severe pain in his right leg 4 days before hospitalization. The patient was admitted and treated with a diagnosis of erysipelas. A few hours after admission, in connection with a drastic deterioration in the general condition and dermatological status, he was transferred to a purulentseptic ward with a fulminant picture of necrotizing fasciitis. Debridement and fasciotomy were performed successfully and timely. Good prognosis and survival in patients with NF correlate directly with the complex of measures. Appropriate antibiotics and intensive general support avoid massive systemic diffusion. Early and adequate surgical debridement and fasciotomy are associated with improved survival.

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Necrotizing Fasciitis of The Abdominal Wall Following Colonoscopy with Fatal Outcome - A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2019.05.06 ◽

2019 ◽

pp. 1-3

Author(s):

Daniel Matz ◽

Oleg Heizmann

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Group A Streptococcus ◽

Subcutaneous Tissue ◽

Fatal Outcome ◽

Anaerobic Bacteria ◽

Tissue Infection ◽

Life Threatening ◽

Staphylococcus Spp

Necrotizing fasciitis (NF) is a serious and potentially life threatening soft tissue infection, usually caused by different types of bacteria such as group A streptococcus, staphylococcus spp. (type 1 infection) or mixed infection by aerobic and anaerobic bacteria (type 2 infection). Usually, the infection arises from skin injury, in injections or surgical procedures and effects the fascia as well as the subcutaneous tissue. Overwhelming progression and difficulties in diagnosing are very common. Mortality rate is up to 100% depending on the type of soft tissue infection and did not markedly decrease in the past decades [1]. Here we present a case of NF with fatal outcome following colonoscopy, which was primarily suspected to be a post polypectomy syndrome.

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Necrotizing Fasciitis: Myalgia Is Diagnostic? A Case Series and Literature Review

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620958605 ◽

2020 ◽

pp. 153473462095860

Author(s):

Sachin Teelucksingh ◽

Vijai Deonarine ◽

Shariful Islam ◽

Shamir O’Cawich ◽

Dave Harnanan ◽

...

Keyword(s):

Soft Tissue ◽

Early Diagnosis ◽

Necrotizing Fasciitis ◽

Subcutaneous Tissue ◽

Case Series ◽

Muscular Activity ◽

Clinical Suspicion ◽

Prompt Treatment ◽

Diagnostic Difficulties ◽

Radiologic Features

Necrotizing fasciitis, commonly known as “flesh-eating disease,” is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.

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A Case of Postsurgical Necrotizing Fasciitis Invading the Rectus Abdominis Muscle and Review of the Literature

Case Reports in Medicine ◽

10.1155/2014/479057 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Francesco Carbonetti ◽

Antonio Cremona ◽

Marco Guidi ◽

Valentina Carusi

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Medical Intervention ◽

Routine Practice ◽

Rectus Abdominis Muscle ◽

Review Of The Literature ◽

Resonance Imaging ◽

General Radiologist ◽

Life Threatening ◽

Common Infections

Necrotizing fasciitis is a life-threatening, soft tissue infection and an early diagnosis is needed to permit a prompt surgical and medical intervention. Due to the high fatal potential of the disease complications, the radiologist should distinguish necrotizing fasciitis from the most common soft tissue infections, in order to permit a prompt surgical and medical treatment. We present a case of a wide necrotizing fasciitis who presented at our emergency department and we also provide the basic tools, through a review of the literature, for the general radiologist to distinguish, with computed tomography and magnetic resonance imaging, necrotizing fasciitis from the most common infections that could present during our routine practice.

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Necrotizing Fasciitis: Diagnostic Challenges and Current Practices

ISRN Infectious Diseases ◽

10.1155/2014/208072 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Abhishek Vijayakumar ◽

Rajeev Pullagura ◽

Durganna Thimmappa

Keyword(s):

Soft Tissue ◽

Early Diagnosis ◽

Necrotizing Fasciitis ◽

Subcutaneous Tissue ◽

Scoring Systems ◽

Risk Groups ◽

Deep Fascia ◽

Superficial Fascia ◽

Diagnosis And Management ◽

Necrotizing Soft Tissue Infections

Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasciitis can be difficult to differentiate from cellulitis and other superficial infections of the skin. In fact, only 15% to 34% of patients with necrotizing fasciitis have an accurate admitting diagnosis. Early diagnosis and management with surgical debridement, antimicrobials, and supportive measures reduce mortality. Even with modern ICU care mortality ranges between 16 and 36%; this is related to delays in diagnosis and comorbidities. Various scoring systems have been developed which help in diagnosis and stratifying patients into risk groups. The present review deals with varied presentation, early diagnosis, and management of necrotizing fasciitis.

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Cervicofacial Emphysema Secondary to Facebow Injury: A Case Report

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.33.4.0110rnkw525455t8 ◽

2009 ◽

Vol 33 (4) ◽

pp. 333-336

Author(s):

Marco Cicciù ◽

Giovanni Battista Grossi ◽

Mario Beretta ◽

Davide Farronato ◽

Concetta Scalfaro ◽

...

Keyword(s):

Case Report ◽

Soft Tissue ◽

Subcutaneous Emphysema ◽

Clinical Case ◽

Dental Procedure ◽

Life Threatening ◽

Facial Area ◽

Orthodontic Device ◽

Physical Findings

Aim: To report the clinical case of a child with facial and periorbital emphysema caused by an orthodontic device. Case report: An 11-year-old child presented to our clinic showing moderate swelling of the left facial area. Based on his dental history, physical findings, and instrument examinations, the diagnosis of cervicofacial emphysema was established, caused by disengagement of the facebow. One week later, all swelling and crepitus had disappeared without complications. Most patients who develop subcutaneous emphysema after a dental procedure have only moderate local swelling, which normally resolves spontaneously and without complications within a week. However, the spread of large amounts of air into the deeper spaces may cause life-threatening sequelae. Conclusions: Orthodontists should be aware that the use of extraoral traction applied via a facebow can cause soft tissue injures and emphysema of the cervicofacial region. It is important to avoid misdiagnosis and to appropriately inform patient and parents about this condition.

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Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review

Pathogens ◽

10.3390/pathogens10070854 ◽

2021 ◽

Vol 10 (7) ◽

pp. 854

Author(s):

Yu-Kuei Lee ◽

Chun-Chieh Lai

Keyword(s):

Soft Tissue ◽

Literature Review ◽

Necrotizing Fasciitis ◽

Subcutaneous Tissue ◽

Superficial Fascia ◽

Upper Eyelid ◽

Case Presentation ◽

Phthisis Bulbi ◽

Eyelid Swelling ◽

The Rich

(1) Background: Necrotizing fasciitis (NF) is an infection involving the superficial fascia and subcutaneous tissue. Endophthalmitis is an infection within the ocular ball. Herein we report a rare case of concurrent periorbital NF and endophthalmitis, caused by Pseudomonas aeruginosa (PA). We also conducted a literature review related to periorbital PA skin and soft-tissue infections. (2) Case presentation: A 62-year-old male had left upper eyelid swelling and redness; orbital cellulitis was diagnosed. During eyelid debridement, NF with the involvement of the upper Müller’s muscle and levator muscle was noted. The infection soon progressed to scleral ulcers and endophthalmitis. The eye developed phthisis bulbi, despite treatment with intravitreal antibiotics. (3) Conclusions: Immunocompromised individuals are more likely than immunocompetent hosts to be infected by PA. Although periorbital NF is uncommon due to the rich blood supply in the area, the possibility of PA infection should be considered in concurrent periorbital soft-tissue infection and endophthalmitis.

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Noma and Necrotizing Fasciitis of the Face and Neck

Facial Plastic Surgery ◽

10.1055/s-0041-1722894 ◽

2021 ◽

Author(s):

Lauren E. Miller ◽

David A. Shaye

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Head And Neck ◽

Subcutaneous Tissue ◽

Neck Region ◽

Superficial Fascia ◽

Soft Tissue Infections ◽

Head And Neck Region ◽

Necrotizing Soft Tissue Infections ◽

The Face

AbstractNecrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.

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Pyelonephritis can be a source of a life threatening necrotizing myofasciitis

Canadian Urological Association Journal ◽

10.5489/cuaj.1787 ◽

2014 ◽

Vol 8 (5-6) ◽

pp. 462

Author(s):

Haytham Kamel ◽

Mohamed Soliman Edris Awed ◽

Ahmed Fouad Kotb

Keyword(s):

Necrotizing Fasciitis ◽

Adult Male ◽

Soft Tissues ◽

Subcutaneous Tissue ◽

Relevant Literature ◽

Deep Fascia ◽

Necrotizing Myositis ◽

Life Threatening

Necrotizing fasciitis is a progressive, rapidly spreading, inflammatory infection located in deep fascia. It may cause necrosis of skin and subcutaneous tissue and can even result in involvement of adjacent soft tissues such as muscles resulting in necrotizing myositis. We report the case of an adult male presenting with necrotizing myofasciitis secondary to left pyelonephritis. We also review the relevant literature.

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Klebsiella Pneumoniae Necrotizing Fascitis of The Lower Extremity in A 7-Month-Old Male: A Case Report and Literature Review

Jurnal Rekonstruksi dan Estetik ◽

10.20473/jre.v4i2.28220 ◽

2021 ◽

Vol 4 (2) ◽

pp. 52

Author(s):

Marelno Zakanito ◽

Iswinarno Saputro

Keyword(s):

Soft Tissue ◽

Klebsiella Pneumoniae ◽

Lower Extremity ◽

Necrotizing Fasciitis ◽

Subcutaneous Tissue ◽

Initial Period ◽

Academic Medical Center ◽

Clinical Manifestations ◽

Lower Limbs ◽

Laboratory Evaluation

Introduction: Klebsiella pneumoniae necrotizing fasciitis is an uncommon soft tissue infection characterized by rapidly progressing necrosis involving the skin, subcutaneous tissue, and fascia. This condition may result in gross morbidity and mortality if not treated in its early stages. In fact, the mortality rate of this condition is high, ranging from 25 to 35%. We present a case of 7-month-old male with K. pneumoniae necrotizing fasciitis of the lower extremity. Materials and Methods: A 7-month-old male presented with large areas over both left and right inferior side of the lower limbs to the emergency department of Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Physical examination revealed elevated heart rate of 136 times per minute and increased body temperature of 38oC. The large areas on both lower limbs were darkened, sloughed off, and very tender to palpation. A small area over the right hand was erythematous and sloughed off. Laboratory evaluation demonstrated decreased hemoglobin of 6.2 g/dL and elevated leukocyte of 28,850 g/dL. Blood cultures demonstrated that K. pneumoniae was present. Discussion: NF is usually hard to diagnose during the initial period. The findings of NF can overlap with other soft tissue infections including cellulitis, abscess or even compartment syndrome. However, pain out of proportion to the degree of skin involvement and signs of systemic shock should alert the clinical to the possibility of NF. The clinical manifestations of NF start around a week after the initiating event, with induration and edema, followed by 24 to 48 hours later by erythema or purple discoloration and increasing local fever In the next 48 to 72 hours, the skin turns smooth, bright, and serous, or hemorrhagic blisters develop. If unproperly treated, necrosis develops, and by the fifth or sixth day, the lesion turns black with a necrotic crust. Conclusions: K. pneumoniae necrotizing fasciitis is a rare but lifethreatening disease. A high index of suspicion is required for early diagnosis and treatment of this condition

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Skin and Soft Tissue Infections

10.2310/em.4081 ◽

2015 ◽

Author(s):

Daniel J. Pallin

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Bacterial Infections ◽

Methicillin Resistant Staphylococcus Aureus ◽

Skin Infections ◽

Soft Tissue Infections ◽

Protective Mechanisms ◽

Contact Precautions ◽

Life Threatening ◽

Plantar Warts

The skin is the largest organ of the human body, and has diverse functions including protection from infection, temperature regulation, sensation, and immunologic and hormonal functions. Skin infections occur when the skin’s protective mechanisms fail. Some infections may be life-threatening (eg, necrotizing fasciitis) or may require the patient to be placed on contact precautions; thus, the initial goals of assessment of patients with skin and soft tissue infections are to assess the patient’s stability and to determine whether precautions are necessary to protect others. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for a variety of skin and soft tissue infections. Figures show an algorithm for treatment of bacterial infections of the skin, and photographs of various infections including necrotizing fasciitis, cellulitis, an abscess caused by methicillin-resistant Staphylococcus aureus, a furuncle, a carbuncle, nonbullous and bullous impetigo, echythma, folliculitis, anthrax lesion, tinea corporis, condyloma acuminatum, and plantar warts. Tables list cellulitis treatment with particular exposures, the dermatophytoses, and yeast infections of skin and mucous membranes. This review contains 16 highly rendered figures, 3 tables, and 32 references.

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