Necrotizing Fasciitis in the Setting of Marine Injury

Abstract

Dr. John Jesus:Today’s case is that of a 26-year-old righthand-dominant healthy patient who sustained a small puncture wound to the hand while disposing of a dead catfish at work. He presented to the Emergency Department (ED) approximately 12 h after his initial injury with significant malaise, chills, and rapidly increasing swelling in the affected hand. The patient reported puncturing the dorsal aspect of his right middle finger with one of the pectoral spines of a catfish at approximately 8:30 in the morning. He attempted to clean the wound by expressing blood from it and washing the wound with warm soapy water. He then went about his day, largely ignoring a seemingly innocuous wound. Shortly before presentation, the patient began to notice increasing pain, erythema, and swelling of the affected finger, quickly tracking up the finger to include the majority of the dorsum of his right hand (Figure 1). Dr. Richard Wolfe: Can you describe the initial appearance of the patient? Dr. Jesus: Upon arrival in the ED the patient was relatively comfortable, initially refusing pain medication. His right middle finger appeared edematous, with mild erythema that was subtle; the puncture wound itself was 3 mm in length, clean, closed, without drainage or visible foreign body. His initial vital signs were: temperature 38.6 C, heart rate 118 beats/min, blood pressure 179/ 93 mm Hg, respiratory rate 18 breaths/min, and an oxygen saturation of 99% on room air. Dr. Carrie Tibbles: Does the patient have any significant past medical history?