Abbate Angelica, Almasio Piero Luigi, Mongitore Martina, Di Vita Gaetano, Patti Rosalia
General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy.
Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy.
Case Rep Surg. 2018 May 8;2018:3945497. doi: 10.1155/2018/3945497. eCollection 2018.
Necrotizing soft tissue fasciitis (NSTIs) or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.
坏死性软组织筋膜炎（NSTIs）或坏死性筋膜炎是一种罕见且严重的感染。在此，我们描述了一名女性患者在臀肌内注射后被诊断为NSTIs的临床过程。我们还报告了对1997年至2017年发表论文的回顾结果。截至目前，已描述了19例肌肉注射后发生NSTIs的病例。我们重点关注肌肉注射与NSTIs发病之间的相关性，特别是在接受皮质类固醇治疗、患有慢性疾病或药物成瘾的免疫抑制患者中。即使正确给药，肌肉注射也可能引发严重的组织创伤，成为局部感染门户。否则，重要的是不要在皮下注射药物，因为皮下是血管化程度较低的区域，因此更容易感染。同样，适当的注射技术和注射前回抽似乎是预防动脉内或动脉旁药物注射及随之而来的大规模炎症反应的有效措施。感染部位的坏死似乎与药物无关，并且是NSTIs的一个强大附加危险因素。
