Agarwal Lekha, Yasin Athar
Emergency Medicine Department, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK.
Int J Emerg Med. 2018 Apr 6;11(1):23. doi: 10.1186/s12245-018-0183-x.
Necrotising fasciitis (NF) is a severe, devastating soft tissue infection characterised by rapidly progressing tissue necrosis. This rare condition has a high mortality rate and poses diagnostic and management challenges to the clinician. There is usually a history of trauma, which maybe trivial. Some of the premorbid conditions associated with NF are diabetes and or immunocompromised state. It requires prompt recognition and early treatment with intravenous antibiotics and extensive surgical debridement.
We describe a 74-year-old lady who presented to our emergency department following 3 days' history of watery diarrhoea and feeling generally unwell. She had signs of severe sepsis and was started on broad-spectrum intravenous antibiotics and fluids for sepsis with unknown source. She was found to have an area of blackish discolouration on her thigh which was suspected as necrotising fasciitis (NF) and referred to the surgeons. She had no history of trauma or significant comorbidity. She underwent surgical exploration and debridement within few hours of arrival into the emergency department and subsequent further debridement with above-knee amputation of the affected limb. She eventually died after about 48 h of hospital stay despite an early diagnosis and prompt surgical debridement and a multidisciplinary approach.
Necrotising fasciitis has been previously reported in literature but we would like to highlight through this case the importance of looking for the source of sepsis by thorough clinical examination and the need to have a high threshold of suspicion for this rare condition and urgent involvement of a surgical team for debridement.
坏死性筋膜炎（NF）是一种严重的、具有毁灭性的软组织感染，其特征为组织坏死迅速进展。这种罕见疾病死亡率高，给临床医生带来诊断和管理方面的挑战。通常有创伤史，可能很轻微。与NF相关的一些病前状况包括糖尿病和/或免疫功能低下状态。它需要通过静脉使用抗生素和广泛的手术清创术进行及时识别和早期治疗。
我们描述一位74岁女性，她因3天的水样腹泻病史且感觉全身不适而到我们的急诊科就诊。她有严重脓毒症的体征，开始接受针对不明来源脓毒症的广谱静脉抗生素和补液治疗。发现她大腿上有一块黑色变色区域，怀疑是坏死性筋膜炎（NF），遂转诊给外科医生。她没有创伤史或重大合并症。她在抵达急诊科后数小时内接受了手术探查和清创，随后对患肢进行了大腿以上截肢的进一步清创。尽管早期诊断、及时手术清创并采取了多学科方法，但她最终在住院约48小时后死亡。
坏死性筋膜炎此前在文献中已有报道，但我们希望通过这个病例强调通过全面临床检查寻找脓毒症来源的重要性，以及对这种罕见疾病保持高度怀疑阈值并让外科团队紧急参与清创的必要性。
