Necrotizing Fasciitis of the Thigh as Unusual Colonoscopic Polypectomy Complication: Review of the Literature with Case Presentation

Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms.

Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Odontogenic Cervicofacial Necrotizing Fasciitis: Microbiological Characterization and Management of Four Clinical Cases

Necrotizing fasciitis of the head and neck is a rare, very severe disease, which, in most cases, originates from odontogenic infections and frequently ends with the death of the patient. Rapid surgical intervention in combination with a preferably pathogen-specific antibiotic therapy can ensure patients’ survival. The question arises concerning which pathogens are causative for the necrotizing course of odontogenic inflammations. Experimental 16S-rRNA gene analysis with next-generation sequencing and bioinformatics was used to identify the microbiome of patients treated with an odontogenic necrotizing infection and compared to the result of the routine culture. Three of four patients survived the severe infection, and one patient died due to septic multiorgan failure. Microbiome determination revealed findings comparable to typical odontogenic abscesses. A specific pathogen which could be causative for the necrotizing course could not be identified. Early diagnosis and rapid surgical intervention and a preferably pathogen-specific antibiotic therapy, also covering the anaerobic spectrum of odontogenic infections, are the treatments of choice. The 16S-rRNA gene analysis detected significantly more bacteria than conventional methods; therefore, molecular methods should become a part of routine diagnostics in medical microbiology.

Laboratory risk indicator for necrotizing fasciitis: an objective scoring system as a tool for early diagnosis of necrotizing fasciitis

Background: Necrotizing soft tissue infections are often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The mortality of 30-40% reflects the inadequacy of early recognition of necrotizing soft tissue infections. This study emphasizes on the search for a tool that reliably and rapidly identifies patients with NF. An objective of current study was to validate the LRINEC score as a tool for early distinguishing of necrotizing fasciitis from other soft tissue infections.Methods: Prospective clinical study analysis of outcome of sixty of patients with soft tissue infections were evaluated based on LRINEC. Based on their LRINEC score, the patients were categorized as low, intermediate and high risk for the onset of necrotizing fasciitis.Results: A total of 60 patients with soft tissue infections were prospectively evaluated and categorized on the basis of LRINEC score 45 patients in low risk category, 7 in Intermediate risk and 8 patients in high risk group. In terms of outcome, all cases (including positive tissue diagnosis cases) in low risk and intermediate risk groups and 2 cases in high risk group were improved with surgical debridement/fasciotomy. The cutoff of LRINEC ≥6 has better sensitivity and specificity in identifying the risk of the patient.Conclusions: LRINEC scoring system has a better positive predictive value in identifying the onset and risk strategizing of necrotizing fasciitis.