Yu K-H, Ho H-H, Chen J-Y, Luo S-F
Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China.
Rheumatology (Oxford). 2004 Apr;43(4):518-21. doi: 10.1093/rheumatology/keh097. Epub 2004 Jan 13.
To analyse the clinical features and outcomes of gout complicated with necrotizing fasciitis.
From the database of our hospital, we identified 15 hospitalized cases of gout complicated with necrotizing fasciitis from 1987 to 2001. The medical records of the patients were analysed in detail.
Mean patient age was 54.7 +/- 12.8 yr. Fever was found in only 10 (66.7%) patients, while the remaining five patients were afebrile on presentation. The peripheral blood white count was raised in only nine (60%) patients. The median time from the onset of symptoms to hospital visit was 4 days (range 2 to 25). Formation of bullae occurred in 60% of patients. Six patients had previous wound infection, two patients had concomitant septic arthritis and the remaining seven patients had no obvious source of infection. Diabetes mellitus and iatrogenic Cushing syndrome were each found in three patients. The identified causative microorganisms were Gram-positive cocci (eight cases) and Gram-negative bacilli (four cases); but in three patients the causative organisms were unknown. Thirteen patients received surgery, including amputation in four cases. Finally, six patients suffered septic shock, three of whom died as a result.
Necrotizing fasciitis in gout patients represents a surgical and medical emergency, and is associated with a high mortality rate. Prompt diagnosis and treatment is imperative and may be lifesaving. Early diagnosis requires a high level of suspicion, even in patients without fever or leucocytosis.
分析痛风合并坏死性筋膜炎的临床特征及结局。
从我院数据库中，我们确定了1987年至2001年期间15例住院的痛风合并坏死性筋膜炎患者。对患者的病历进行了详细分析。
患者平均年龄为54.7±12.8岁。仅10例（66.7%）患者出现发热，其余5例患者就诊时无发热。仅9例（60%）患者外周血白细胞计数升高。从症状出现到就诊的中位时间为4天（范围2至25天）。60%的患者出现大疱形成。6例患者既往有伤口感染，2例患者合并化脓性关节炎，其余7例患者无明显感染源。3例患者患有糖尿病，3例患者患有医源性库欣综合征。确定的致病微生物为革兰氏阳性球菌（8例）和革兰氏阴性杆菌（4例）；但3例患者的致病微生物不明。13例患者接受了手术，其中4例行截肢手术。最后，6例患者发生感染性休克，其中3例死亡。
痛风患者的坏死性筋膜炎是一种外科和内科急症，死亡率高。及时诊断和治疗至关重要，可能挽救生命。即使在无发热或白细胞增多的患者中，早期诊断也需要高度怀疑。
