Necrotizing fasciitis – a diagnostic dilemma: two case reports

Abstract

IntroductionNecrotizing soft tissue infections can affect various tissue planes. Although predisposing etiologies are many, they mostly center on impaired immunity occurring directly or indirectly and loss of integrity of protective barriers which predispose to infection. The nonspecific presentation may delay diagnosis and favor high mortality.Case presentationTwo case vignettes are presented. The first patient, a 44-year-old healthy South Asian man with a history of repeated minor traumatic injury presented to a primary health care center with a swollen left lower limb. He was treated with antibiotics with an initial diagnosis of cellulitis. Because he deteriorated rapidly and additionally developed intestinal obstruction, he was transferred to our hospital which is a tertiary health care center for further evaluation and management. Prompt clinical diagnosis of necrotizing soft tissue infection was made and confirmed on magnetic resonance imaging as necrotizing fasciitis. Urgent debridement was done, but the already spread infection resulted in rapid clinical deterioration with resultant mortality. The second patient was a 35-year-old South Asian woman with systemic lupus erythematous receiving immunosuppressive therapy who developed left lower limb pain and fever. Medical attention was sought late as she came to the hospital after 4 days. Her condition deteriorated rapidly as she developed septic shock and died within 2 days.ConclusionsNecrotizing fasciitis can be fatal when not recognized and without early intervention. Clinicians and surgeons alike should have a greater level of suspicion and appreciation for this uncommon yet lethal infection.

The red leg dilemma: a scoping review of the challenges of diagnosing lower‐limb cellulitis

“…The pathologies were grouped by specialty: vascular (nine pathologies) was the most common group . Necrotizing fasciitis, sarcoidosis, lymphoma and chemotherapy‐related pathology had the most case reports or series as a misdiagnosis.…”

Cellulitis of the Knee in a 16-Month-Old Boy: A Case Report

“…Cellulitis in the lower extremities is most common in the geriatric population. 6,[10][11][12][13][14]29,31,32 …”

“…Other common presentations are seen among patients with a body mass index higher than 31, geriatric patients, and patients with a history of diabetes or immune compromise. 6,[9][10][11][12][13][14] The presentation of cellulitis to a chiropractic clinic is not commonly reported in the literature. At present, only 1 case report exists which describes the www.journalchiromed.com presentation in an adolescent.…”

“…It is clinically diagnosed based on the presentation of a nonpurulent erythemic rash with irregular margins, edema, and local tenderness. [1][2][3][4][5][6][7][8] The most common presentation for cellulitis of the lower extremities is a secondary condition due to trauma, which is most commonly seen in sports-related trauma or trauma involving foreign bodies. Other common presentations are seen among patients with a body mass index higher than 31, geriatric patients, and patients with a history of diabetes or immune compromise.…”

Necrotizing Fasciitis is a Rare Complication after Bone Marrow Transplantation: A Case Report

“…Necrotizing fasciitis is an uncommon disease and is considered a rare and potentially fatal condition [1,2] that results in gross morbidity and mortality if not diagnosed and treated in its early stages [3,4]. Necrotizing fasciitis is a soft tissue infection that spreads along fascial planes with associated inflammation and necrosis [1].…”