Abstract
Necrotizing fasciitis is an uncommon and deadly disease entity characterized by rapidly progressing skin and soft tissue destruction. It presents on a spectrum from an initially indolent appearing sub-acute form to a hyperacute fulminant course. It may often be misdiagnosed due to the paucity of signs early in the disease course and as it can initially mimic other less serious soft tissue infections. Necrotizing soft tissue infections have both high morbidity and mortality.We present a case of a 72-year-old male patient with two anatomically and temporally separate necrotizing infections. The first necrotizing infection was diagnosed after an extended time, due to the subacute disease course in the setting of an abdominal wall infection. The second presentation was a hyperacute fulminant course in the setting of a necrotizing infection of the scrotum. In both instances, once identified, appropriate management was followed: resuscitation, broad-spectrum antibiotics, and most importantly radical surgical debridement. Extensive multidisciplinary inpatient and outpatient input was required to aid the patient’s recovery.The presented case demonstrates the necrotizing soft tissue infection’s spectrum of disease and the diagnostic dilemma it presents to family physicians and emergency departments alike. The only definitive management step is immediate and radical resection of the affected tissue. Extensive debridement and the resultant tissue defect require comprehensive multidisciplinary care during the extended rehabilitation and wound care treatment plan. Rapid recognition, urgent surgical debridement, and specialist care are required to reduce the mortality and morbidity associated with necrotizing soft tissue infections.
Highlights
Necrotizing fasciitis is an uncommon and deadly disease entity characterized by rapidly progressing skin and soft tissue destruction
Necrotizing soft tissue infection (NSTI), known as necrotizing fasciitis, is an uncommon disease entity that is characterised by rapidly progressing skin and soft tissue destruction [1,2] with a high mortality rate
This patient had many of the risk factors. This warrants a higher clinical suspicion for NTSI. In addition to these risk factors which may raise the index of suspicion for a diagnosis of NSTI, Wong et al developed a Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score [19]
Summary
Necrotizing soft tissue infection (NSTI), known as necrotizing fasciitis, is an uncommon disease entity that is characterised by rapidly progressing skin and soft tissue destruction [1,2] with a high mortality rate. Sub-acute NSTIs are indolent and of a protracted time course eventually resulting in an acute deterioration This case report details a patient with two anatomically and temporally separate presentations of a necrotizing infection, exhibiting different manifestations of the disease. A diagnosis of NTSI of the scrotum was made, known as Fournier’s gangrene During this 28-day admission microbial wound swabs, tissue, urine, blood, and faecal cultures showed no growth. This was likely due to sustained broad-spectrum antibiotic therapies during his disease course. The patient was discharged on day 169 with return to near baseline and/or accepted normal parameters for all bloods (Table 1) Throughout his hospitalization the patient received care from a plethora of specialist teams including general surgery, urology and plastic surgery for debridement and reconstruction. At day 249 the patient is living independently and has a reasonable quality of life
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