糖尿病患者に発症した壊そ性筋膜炎の一症例

Abstract

The patient was a 55-year-old female with a 10-year history of diabetes. On July 1, 2004, swelling at the tip of the third digit (left hand) developed, although definite cause is unknown. From July 3, redness and swelling increased and she visited a nearby doctor for examination. Exacerbated symptoms were found and the patient was admitted to our hospital on July 7. Upon hospitalization, with the exception of the finger tip, a dark red color, swelling and pressure point pain were seen. Inflammation and laboratory findings (CRP:15.1 WBC:11500) were detected, but bacteria was not found in culture. (After hospitalization) On July 9, the diagnosis of necrotizing fasciitis was uncertain. The patient was immediately treated by hyperbaric oxygen (HBO) therapy and intravenous antibiotics. No symptomic improvement was seen. Debridement and amputation of the third digit were performed. On July 13, an expansion of necrotizing tissue on the dorsal side of the hand was found and additional wide area debridement was peformed. On July 18, pig skin coating (brand name:Aroask) was used and no furter growth of necrosis had been seen. Wound granulation was slow.As a result, it can be said that wide debridement of necrotizing fasciitis including areas of reduess and edema shoud be peformed.Also, surgical treatment by adequate debridement, drug therapy by antibiotics, and HBO therapy should be combined to treat necrotizing fasciitis.