Post-Panaris Necrosating Fasciitis of the Right Upper Limb in a Case Observed at the Markala Reference Health Center

Abstract

Necrotizing fasciitis is an infection of the skin and deep subcutaneous tissues, spreading along the fasciae and adipose tissue, mainly caused by Group A streptococcus (Streptococcus pyogenes) but also by other bacteria such as Vibrio vulnificus, Clostridium perfringens or Bacteroides fragilis. Objective: To report a case of Necrotizing Fasciitis received at the Markala Reference Health Center. Clinical observation: It was a 45-year-old rice farmer with no known medical-surgical history received for an extensive wound on the right upper limb evolving for three months with impaired general condition and consciousness. The onset of the symptomatology dates back to about 3 months marked by a paronychia of the pulp of the right thumb extended secondarily to the right forearm. The physical examination finds an extensive necrotic wound of the right upper limb presenting voluminous blisters of brown color with a black background filled with purulent and smelly serosities. The diagnosis of Necrotizing Fasciitis was strongly suspected due to the presence of Pyogenic Streptococcus (Sensitive to gentamycin and Amoxicillin) in the pus sample. The patient was therefore put on antibiotic therapy combining Clavulanic acid at a rate of 2g x 3 per day and gentamicin at a rate of 160 mg per day with wide excision of necrotic tissues under general anesthesia in the operating room followed by a daily dressing with 30V hydrogen peroxide and Polyvidone iodine. The evolution was very favorable with a directed healing on D16. Conclusion: Necrotizing fasciitis is distinguished by its increasingly increasing and worrying frequency, its clinical severity and its detrimental character from a functional and vital point of view, which is why its management must be early.