Spiridakis K G, Intzepogazoglou D S, Flamourakis M E, Sfakianakis E E, Daskalaki A V, Vakonaki E K, Rahmanis E, Kostakis G E, Christodoulakis M S
G Chir. 2017 May-Jun;38(3):130-134. doi: 10.11138/gchir/2017.38.3.130.
Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the deeper skin layers and subcutaneous tissues that moves along the facial planes.
We present the rare case of a patient with necrotizing fasciitis associated with high malignancy b-cell lymphoma. Our purpose is to investigate the probable connection between the two pathologies and evaluate the importance of early surgical intervention.
51-year old Caucasian woman presented at the E.R. with history of a painful left thigh over a week and fever up to 38,4°C over the last three days. Necrosis of the soft tissues and fascial planes were observed clinically. After the initial treatment and due to the patient's multiple organ dysfunction (septic shock), she was transferred to the ICU were she was intubated resuscitated with IV fluids and given IV antibiotics. 24 hours after the admission it was decided that the patient should undergo surgery and an extensive debridement of the necrotic area was performed. The antibiogram of the blood culture revealed streptococcus pyogenes and she was administered penicillin while intubated and monitored in the ICU until the seventh postoperative day. On the eighth post-day she was transferred back to the surgical department, hemodynamically normal and stable. She was discharged one month later and she was referred to a plastic surgery center for the final reconstruction surgery.
This case highlights that the high index of suspicion and the early aggressive surgical intervention seems to be very critical to improve survival of the patients with necrotizing fasciitis.
坏死性筋膜炎是一种沿筋膜平面迅速进展且危及生命的深层皮肤和皮下组织感染。
我们报告一例罕见的坏死性筋膜炎合并高恶性B细胞淋巴瘤患者。我们的目的是研究这两种病理状况之间可能的联系，并评估早期手术干预的重要性。
一名51岁的白种女性因左大腿疼痛一周且在过去三天体温高达38.4°C就诊于急诊室。临床观察到软组织和筋膜平面坏死。初始治疗后，由于患者出现多器官功能障碍（感染性休克），被转入重症监护病房，在那里进行了气管插管，通过静脉输液复苏，并给予静脉抗生素治疗。入院24小时后，决定对患者进行手术，并对坏死区域进行了广泛清创。血培养的抗菌谱显示为化脓性链球菌，在重症监护病房气管插管期间给予青霉素治疗，并持续监测直至术后第七天。术后第八天，她转回外科，血流动力学正常且稳定。一个月后出院，并被转诊至整形手术中心进行最终重建手术。
该病例强调，高度怀疑和早期积极的手术干预对于提高坏死性筋膜炎患者的生存率似乎至关重要。
