School of Medicine, Poznań University of Medical Sciences, Poznań, Poland.
Department of Medicine, Tufts Medical Center, Boston, MA, USA.
Am J Case Rep. 2020 Jul 18;21:e924110. doi: 10.12659/AJCR.924110.
BACKGROUND We present a case of a 24-year-old woman with type 1- diabetes mellitus who developed necrotizing fasciitis (NF) due to Streptococcus agalactiae after a recent colposcopy. Literature review suggests this as the first case to be reported. CASE REPORT The patient initially presented to the emergency department (ED) with right lower neck pain and spasm of the right sternocleidomastoid muscle (SCM), with decreased range of motion. She was diagnosed with torticollis and was sent home on a nonsteroidal anti-inflammatory drug and spasmolytic. She returned 5 days later because of a lack of response. Magnetic resonance imaging of her neck revealed edema and inflammatory changes in the distal portion of her right SCM; an oral-systemic steroid was added to her treatment. However, she presented to the ED 3 days after her second visit with worsening symptoms. Her complaints of severe pain involving the right chest wall, development of fever, and the findings on imaging studies prompted the diagnosis of necrotizing soft-tissue infection and NF. She promptly underwent successful surgical debridement. Tissue cultures grew abundant Streptococcus agalactiae. Her antibiotics were readjusted and she was discharged to rehabilitation. Retrospective analysis of the case was notable for colposcopy with cervical biopsy and endocervical curettage for chronic cervicitis and low-grade squamous intraepithelial lesion within a week of her first ED visit. CONCLUSIONS NF caused by Streptococcus agalactiae should be suspected in patients who have had recent genitourinary/gastrointestinal procedures.
我们报告了 1 例 24 岁的 1 型糖尿病女性患者，她在最近的阴道镜检查后因无乳链球菌感染导致坏死性筋膜炎（NF）。文献回顾表明，这是首例报道的病例。
患者最初因右侧下颈部疼痛和右侧胸锁乳突肌（SCM）痉挛，活动范围减小而到急诊科就诊。她被诊断为斜颈，并在服用非甾体抗炎药和肌松药后被送回家。5 天后，由于没有反应，她又回到了医院。她的颈部磁共振成像显示右侧 SCM 远端有水肿和炎症改变；她的治疗方案中增加了口服全身性类固醇。然而，在第二次就诊后的第 3 天，她因症状恶化再次到急诊科就诊。她右侧胸痛、发热，并伴有影像学检查结果，促使医生诊断为坏死性软组织感染和 NF。她立即接受了成功的外科清创术。组织培养显示大量无乳链球菌生长。她的抗生素进行了调整，随后出院到康复科。对该病例的回顾性分析发现，在她首次到急诊科就诊的一周内，曾进行阴道镜检查和宫颈活检及宫颈内膜刮除术，以治疗慢性宫颈炎和低度鳞状上皮内病变。
对于近期有泌尿生殖/胃肠道手术的患者，应怀疑有无乳链球菌引起的 NF。
