Lohiya Ghan-Shyam, Tan-Figueroa Lilia, Krishna Vijay, Lohiya Sunita
Department of Public Health, Fairview Developmental Center, Costa Mesa, CA 92626, USA.
Case Rep Med. 2012;2012:253906. doi: 10.1155/2012/253906. Epub 2012 Nov 4.
A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient's right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C), and leukocytosis (count: 13 × 10(9)/L; was 6.5 × 10(9)/L ten days earlier). Necrotizing fasciitis (NF) was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.
一名27岁的卧床不起的哑巴患者因急性呼吸道疾病需要肠外使用皮质类固醇和抗生素，并住院治疗。两天后，医护人员注意到患者右脚跟出现一个约0.3厘米的水泡。在19小时内，水泡增大，足部部分坏疽。患者出现高热（40.3°C）和白细胞增多（计数：13×10⁹/L；十天前为6.5×10⁹/L）。诊断为坏死性筋膜炎（NF），并进行了紧急腿部截肢治疗。组织病理学显示筋膜、肌肉、皮下组织和皮肤坏死。对于卧床患者，皮质类固醇可能特别容易引发严重感染，而且坏死性筋膜炎最初的水泡可能被误诊为压疮。对于所有无法表达自身症状的患者，进行警惕且频繁的全身监测是必要的。
