Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark.
BMC Infect Dis. 2019 Apr 29;19(1):358. doi: 10.1186/s12879-019-3969-4.
Necrotizing fasciitis is a deep infection of the fascia and subcutaneous tissue with a high mortality rate. Meningitis is an infection of the membranes surrounding the brain with a likewise high mortality rate. Streptococcus pneumoniae is the most frequent cause of bacterial meningitis and it is an extremely rare cause of necrotizing fasciitis. Different subcapsular serotypes of S. pneumoniae are known to have diverse virulence. The serotype 9 N is associated with a high risk of death.
We report a case of a previously healthy 68-year-old female who presented at our clinic with complaints of pain in her left calf since having experienced a very painful leg cramp 3 weeks prior. Within a few hours after admission, she developed fever, neck stiffness and an altered mental state. Concurrently, the pain in her leg worsened. Upon further examination it was found that she suffered from both meningitis and necrotizing fasciitis due to S. pneumoniae, serotype 9 N. The patient survived and avoided leg amputation.
The patient suffered from two very lethal infections simultaneously. Both of them were caused by S. pneumoniae. We believe that her favorable outcome was, a result of prompt surgical intervention and appropriate antibiotic treatment. Our case underlines the importance of continuous reevaluation of the symptoms and clinical findings in patients with unclear causes of severe illness, especially if the patient's condition changes.
坏死性筋膜炎是一种深筋膜和皮下组织的高死亡率感染。脑膜炎是脑膜的感染，死亡率同样很高。肺炎链球菌是细菌性脑膜炎最常见的病因，也是坏死性筋膜炎极罕见的病因。不同的荚膜血清型肺炎链球菌具有不同的毒力。血清型 9N 与高死亡率相关。
我们报告了一例先前健康的 68 岁女性，她因 3 周前经历了一次非常疼痛的腿部痉挛而出现左小腿疼痛，来到我们诊所就诊。入院后几个小时内，她出现发热、颈部僵硬和精神状态改变。同时，腿部疼痛加剧。进一步检查发现，她同时患有脑膜炎和由肺炎链球菌、血清型 9N 引起的坏死性筋膜炎。患者幸存下来，避免了截肢。
该患者同时患有两种非常致命的感染。两者均由肺炎链球菌引起。我们认为她的良好预后是由于及时的手术干预和适当的抗生素治疗。我们的病例强调了对不明原因严重疾病患者的症状和临床发现进行持续重新评估的重要性，特别是如果患者的病情发生变化。
