Chen Ching-En, Shih Yu-Chung
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital; and †Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taiwan, Republic of China.
Ann Plast Surg. 2017 Mar;78(3 Suppl 2):S28-S31. doi: 10.1097/SAP.0000000000001001.
Necrotizing fasciitis is one of the most life-threatening soft tissue infections and usually follows a major or minor trauma. Published reports regarding single microorganism liver abscess caused by Klebsiella pneumoniae in Taiwan indicate a septic metastasis rate about 12%. Although a hematogenous origin of necrotizing fasciitis from a liver abscess is rare in Taiwan, it remains possible in our clinical practice.
A 75-year-old man with a history of diabetes and liver abscess had a status of postdrainage 5 years earlier. The patient presented with elevated body temperature, swelling, and pain over the left hand and forearm for 4 days before coming to our emergency room. We performed a fasciotomy procedure under the preliminary diagnosis of necrotizing fasciitis. The patient's blood cultures yielded K. pneumoniae, and therefore recurrence of liver abscess was confirmed by ultrasonography. After treating with percutaneous drainage and third cephalosporin intravenously, the patient recovered and discharged on the 50th day after admission.
Necrotizing fasciitis is a life-threatening soft tissue infectious disease. Once K. pneumoniae is identified both in blood and wound cultures of a diabetic patient with necrotizing fasciitis, it is recommended that the metastatic lesions undergo complete abdominal evaluation by the hematogenous route.
坏死性筋膜炎是最危及生命的软组织感染之一，通常继发于严重或轻微创伤之后。台湾有关肺炎克雷伯菌引起的单一微生物肝脓肿的已发表报告显示，脓毒症转移率约为12%。虽然在台湾，肝脓肿血源性引发坏死性筋膜炎的情况很少见，但在我们的临床实践中仍有可能发生。
一名75岁男性，有糖尿病和肝脓肿病史，5年前曾行引流术。该患者在前来我们急诊室就诊前4天，出现体温升高、左手及前臂肿胀和疼痛。我们在初步诊断为坏死性筋膜炎的情况下进行了筋膜切开术。患者血培养出肺炎克雷伯菌，因此通过超声检查证实肝脓肿复发。经皮引流并静脉注射第三代头孢菌素治疗后，患者在入院第50天康复出院。
坏死性筋膜炎是一种危及生命的软组织感染性疾病。一旦在患有坏死性筋膜炎的糖尿病患者的血液和伤口培养物中均发现肺炎克雷伯菌，建议对转移性病变通过血行途径进行全面的腹部评估。
