scholarly journals Fulminant necrotizing fasciitis of the thigh, following an infection of the sacro-iliac joint in an immunosuppressed, young woman

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Martin Gothner ◽  
Marcel Dudda ◽  
Christiane Kruppa ◽  
Thomas A. Schildhauer ◽  
Justyna Swol
Keyword(s):  
Drug Abuse ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Rare Complication ◽  
Good Condition ◽  
Surgical Debridement ◽  
Soft Tissue Coverage ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Split Skin

Necrotizing soft tissue infection of an extremity is a rare but life-threatening disease. The disease is an infection that involves the soft tissue layer and is characterized by rapidly spreading inflammation (especially of the fascial planes and the surrounding tissues) with a high mortality. Early diagnosis is essential for the outcome of the patients. Radical surgical debridement is the treatment of choice. The predisposing factors are immunosuppression, diabetes mellitus and drug abuse. This report presents a case of necrotizing fasciitis in the thigh, following an abscess of the sacro-iliac joint, as a rare complication in a young, immunosuppressed woman. The patient’s history revealed intra-venous drug abuse and hepatitis C. After immediate diagnosis by magnetic resonance imaging, radical surgical debridement was required and performed. Prior to soft tissue coverage with a split skin graft, five additional sequential debridements were necessary. During her hospital stay, the patient experienced further cerebral and pulmonary septic embolisms and an infection of the elbow. Six months after admission, the patient was discharged in good condition to a rehabilitation center. Necrotizing fasciitis is a life-threatening complication following an abscess of the sacro-iliac joint. Physicians must be vigilant to inflammatory signs and pain in immunosuppressed patients. An abscess of the sacro-iliac joint is rare, but complications of an untreated abscess can be fatal in these patients.

scholarly journals A rare case of varicella gangrenosum in adult

2020 ◽  
Vol 7 (2) ◽  
pp. 599
Author(s):  
M. Sabari Girieasen ◽  
Naveenkumar Viswanathan ◽  
M/ S. Kalyankumar
Keyword(s):  
Soft Tissues ◽  
Rare Complication ◽  
Purpura Fulminans ◽  
The Body ◽  
Surgical Debridement ◽  
Chicken Pox ◽  
Serous Discharge ◽  
Threatening Condition ◽  
Life Threatening ◽  
Split Skin

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. It most commonly occurs in children less than 5 years of age and life threatening. This is a very rare complication of chicken pox in adults which deserves early diagnosis and management. 21-year-old male presented with blackish discoloration in the lateral aspect of right thigh for 5 days. He has positive history of chicken pox for his brother and sister following which he acquired it 15 days back. During that episode he had fever, headache and blisters which ruptured to heal by scab. But scab in right thigh coalesced to form the gangrenous area with serous discharge. On presentation he had no fever with local lesion and surrounding erythema. Patient underwent radical surgical debridement and regular dressing. Pus culture was sent which showed no growth. He gradually improved and the ulcer granulated well and split skin graft is done. Varicella gangrenosum is a life-threatening condition which can be either wet, moist or purpura fulminans. Patients who develop disseminated intravascular coagulation and have a grave prognosis. Surgical debridement is the only proven treatment which has led to better outcome. Only about 10 cases reported in literature so far regarding this condition. 

scholarly journals Cervical Necrotizing Fasciitis, Diagnosis and Treatment of a Rare Life-Threatening Infection

2021 ◽  
pp. 014556132199134
Author(s):  
Jack Hua ◽  
Paul Friedlander
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Definitive Diagnosis ◽  
Clinical Suspicion ◽  
Plain Radiography ◽  
Surgical Debridement ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Life Threatening ◽  
Fat Stranding

Importance: Necrotizing fasciitis is a relatively uncommon and potentially life-threatening soft tissue infection, with morbidity and mortality approaching 25% to 35%, even with optimal treatment. The challenge of diagnosis for necrotizing soft tissue infections (NSTIs) is their rarity, with the incidence of approximately 1000 cases annually in the United States. Given the rapid progression of disease and its similar presentation to more benign processes, early and definitive diagnosis is imperative. Findings: Signs and symptoms of NSTIs in the early stages are virtually indistinguishable from those seen with abscesses and cellulitis, making definitive diagnosis difficult. The clinical presentation will depend on the pathogen and its virulence factors which ultimately determine the area and depth of invasion into tissue. There are multiple laboratory value scoring systems that have been developed to support the diagnosis of an NSTI. The scoring system with the highest positive (92%) and negative (96%) predictive value is the laboratory risk indicator for necrotizing fasciitis (LRINEC). The score is determined by 6 serologic markers: C-reactive protein (CRP), total white blood cell (WBC) count, hemoglobin, sodium, creatinine, and glucose. A score ≥ 6 is a relatively specific indicator of necrotizing fasciitis (specificity 83.8%), but a score <6 is not sensitive (59.2%) enough to rule out necrotizing fasciitis. In terms of imaging, computed tomography (CT) imaging, while more sensitive (80%) than plain radiography in detecting abnormalities, is just as nonspecific. Computed tomography imaging of NSTIs demonstrates fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Magnetic resonance imaging (MRI) has demonstrated sensitivity of 100% and specificity of 86%, though MRI may not show early cases of fascial involvement of necrotizing fasciitis. Conclusions and Relevance: Necrotizing soft tissue infections are rapidly progressive and potentially fatal infections that require a high index of clinical suspicion to promptly diagnose and aggressive surgical debridement of affected tissue in order to ensure optimal outcomes. Prompt surgical and infectious disease consultation is necessary for the treatment and management of these patients. While imaging is useful for further characterization, it should not delay surgical consultation. Necrotizing soft tissue infection remains a clinical diagnosis, although plain radiography, CT imaging, and ultrasound can provide useful clues. In general, the management of these patients should include rapid diagnosis, using a combination of clinical suspicion, laboratory data (LRINEC score), and imaging (MRI being the recommended imaging modality), prompt infectious disease and surgical consultation, surgical debridement, and delayed reconstruction. Laboratory findings that can more strongly suggest a diagnosis of NSTI include elevated CRP, elevated WBC, low hemoglobin, decreased sodium, and increased creatinine. Imaging findings include fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Broad-spectrum antibiotics should be started in all cases of suspected NSTI. Surgical debridement, however, remains the lynchpin for treatment of cervical necrotizing fasciitis.

Skin and Soft Tissue Infections

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.

scholarly journals Diagnosis and management of necrotizing fasciitis in the light of the recent recommendations

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 77-84
Author(s):  
C. O. Kosulnikov ◽  
V. N. Lisnichaya ◽  
A. M. Besedin ◽  
S. І. Karpenko ◽  
S. A. Tarnopolsky ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Subcutaneous Fat ◽  
Surgical Debridement ◽  
Type I ◽  
Cause Of Deaths ◽  
Life Threatening ◽  
Management Modality ◽  
Closure Method ◽  
Primary Management

Summary: Necrotizing fasciitis is a rare but life-threatening infection of the soft tissues. It is characterized by spreading inflammation and necrosis starting from the fascia, muscles, and subcutaneous fat, with subsequent necrosis of the overlying skin. Necrotizing fasciitis is classified into four types, depending on microbiological findings. The diagnosis of this disease is difficult. Late diagnosis is observed in 85–100% of cases and is considered the only cause of deaths. Emergency surgical debridement is the primary management modality for necrotizing fasciitis. Vacuum assisted closure therapy is fast and effective wound closure method. Antibiotics and surgical debridement play a key role in the treatment of necrotizing fasciitis.In our hospital, there were 75 patients with necrotizing fasciitis in the last 5 years (type I – 92%, type II – 8%). We observed localization of necrotizing fasciitis in the perineum (32%), upper extremities and chest (25%), lower extremities (28%), abdominal wall and retroperitoneal space (15%). Mortality was 9,5%. Keywords: necrotizing fasciitis, sepsis, surgical debridement.

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

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.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
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.

Vibrio vulnificus-Induced Necrotizing Fasciitis Complicated by Multidrug-Resistant Acinetobacter baumannii Infection: Efficacy of Chemical Necrectomy Using 40% Benzoic Acid

2021 ◽  
pp. 153473462110043
Author(s):  
Bretislav Lipový ◽  
Radomir Mager ◽  
Filip Raška ◽  
Marketa Hanslianová ◽  
Josef Blažek ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Benzoic Acid ◽  
Necrotizing Fasciitis ◽  
Acinetobacter Baumannii ◽  
Soft Tissue Infection ◽  
Vibrio Vulnificus ◽  
Tissue Infection ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Life Threatening

Necrotizing fasciitis is a life-threatening skin and soft tissue infection associated with high morbidity and mortality in adult patients. This infection can present as either type 1 infection caused by a mixed microflora ( Streptococci, Enterobacteriacae, Bacteroides sp., and Peptostreptococcus sp.), most commonly developing in patients after surgery or in diabetic patients, or as type 2. The latter type is monomicrobial and, usually, caused by group A Streptococci. Rarely, this type can be also caused by other pathogens, such as Vibrio vulnificus. V vulnificus is a small mobile Gram-negative rod capable of causing 3 types of infections in humans—gastroenteritis, primary infection of the vascular bed, and wound infections. If infecting a wound, V vulnificus can cause a life-threatening condition—necrotizing fasciitis. We present a rare case of necrotizing fasciitis developing after an insect bite followed by exposure to the seawater. Rapid propagation of the infectious complication in the region of the right lower limb led to a serious consideration of the necessity of amputation. Due to the clearly demarcated necroses and secondary skin and soft tissue infection caused by a multiresistant strain of Acinetobacter baumannii, we, however, resorted to the use of selective chemical necrectomy using 40% benzoic acid—a unique application in this kind of condition. The chemical necrectomy was successful, relatively gentle and thanks to its selectivity, vital parts of the limb remained preserved and could have been subsequently salvaged at minimum blood loss. Moreover, the antimicrobial effect of benzoic acid led to rapid decolonization of the necrosis and wound bed preparation, which allowed us to perform defect closure using split-thickness skin grafts. The patient subsequently healed without further complications and returned to normal life.

scholarly journals JC Polyomavirus and Transplantation: Implications for Virus Reactivation after Immunosuppression in Transplant Patients and the Occurrence of PML Disease

2021 ◽  
Vol 2 (1) ◽  
pp. 37-48
Author(s):  
James E. K. Hildreth ◽  
Donald J. Alcendor
Keyword(s):  
Inflammatory Responses ◽  
Rare Complication ◽  
Organ Transplant ◽  
Solid Organ ◽  
Virus Reactivation ◽  
Jc Polyomavirus ◽  
Hematological Disorders ◽  
Transplant Patients ◽  
Immunosuppressed Patients ◽  
Life Threatening

The JC polyomavirus (JCPyV/JCV) is a member of the Polyomaviridae family and is ubiquitious in the general population, infecting 50–80% of individuals globally. A primary infection with JCV usally results in an asymptomatic, persistent infection that establishes latency in the renourinary tract. Reactivation from latency via iatrogenic immununosuppression for allograft transplantation may result in organ pathology and a potential life-threatening neuropathological disease in the form of progressive multifocal leukoencephalopathy (PML). Currently, no treatment exists for PML, a rare complication that occurs after transplantation, with an incidence of 1.24 per 1000 persons a year among solid organ transplant patients. PML is also observed in HIV patients who are immununosuppressed and are not receiving antiretroviral therapy, as well as individuals treated with biologics to suppress chronic inflammatory responses due to multiple sclerosis, Crohn’s disease, non-Hodgkin’s lymphoma, rheumatoid arthritis, and other autoimmune-mediated hematological disorders. Here, we describe the proposed mechanisms of JCV reactivation as it relates to iatrogenic immunosuppression for graft survival and the treatment of proinflammatory disease, such as biologics, proposed trafficking of JCV from the renourinary tract, JCV central nervous system dissemination and the pathology of PML in immunosuppressed patients, and potential novel therapeutics for PML disease.

scholarly journals Necrotizing fasciitis caused by Pseudomonas aeruginosa: a rare case report and recent concepts in diagnosis and management

2020 ◽  
Vol 6 (5) ◽  
pp. 1100
Author(s):  
Naresh Kumar ◽  
Akshay Lamba ◽  
Jyotirmay Das ◽  
Avik K. Neogi ◽  
Kunal Arora ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Rare Case ◽  
Functional Deficits ◽  
Rare Case Report ◽  
Life Threatening ◽  
Pseudomonas Infection ◽  
Early Debridement

<p>Necrotizing fasciitis caused by <em>Pseudomonas aeruginosa</em> is an extremely rare and life threatening bacterial soft tissue infection. Here we report a case study of fully established necrotizing fasciitis associated with monomicrobial pseudomonas infection in a 34 years old male. The patient presented with painful, necrosed areas of skin and soft tissue over right gluteal region which rapidly progressed to right upper back. Aggressive supportive measures and early debridement lead to a full recovery with no functional deficits.</p>

scholarly journals Necrotizing Fasciitis Associated withStaphylococcus lugdunensis

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Tony Hung ◽  
Soroush Zaghi ◽  
Jonathan Yousefzadeh ◽  
Matthew Leibowitz
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Staphylococcal Infection ◽  
Tissue Destruction ◽  
First Case ◽  
Life Threatening ◽  
Group A ◽  
Group B

Necrotizing fasciitis is a life-threatening soft tissue infection that results in rapid local tissue destruction. Type 1 necrotizing fasciitis is characterized by polymicrobial, synergistic infections that are caused by non-Group Astreptococci, aerobic and anaerobic organisms. Type 2 necrotizing fasciitis involves Group AStreptococcus(GAS) with or without a coexisting staphylococcal infection. Here we provide the first report of necrotizing fasciitis jointly associated with the microbes Group BStreptococcusandStaphylococcus lugdunensis.S. lugdunensisis a commensal human skin bacterium known to cause often painful and prolonged skin and soft tissue infections. To our knowledge, however, this is the first case ofStaph. lugdunensis-associated necrotizing fasciitis to be reported in the literature.

Sign in / Sign up

Export Citation Format

Share Document