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病例报告:一名病态肥胖的糖尿病青年男性发生社区获得性坏死性筋膜炎可能会致命。

A case report: Community-acquired necrotizing fasciitis in a morbidly obese diabetic young man can be fatal.

作者信息

Mazlan Mohd Zulfakar, Zainal Abidin Huda, Wan Hassan Wan Mohd Nazaruddin, Nik Mohamad Nik Abdullah, Salmuna Zeti Norfidiyati, Ibrahim Kamaruddin, Omar Mahamarowi, Abdul-Aziz Mohd Hafiz

机构信息

Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia.

Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia.

出版信息

IDCases. 2020 Nov 2;22:e01001. doi: 10.1016/j.idcr.2020.e01001. eCollection 2020.

Abstract

We present a case study of a 26-year-old morbidly obese man with a three-day history of right leg pain and swelling. The swelling was associated with low grade fever. He was alert and conscious upon presentation to the hospital. His physical examination showed gross swelling of the entire right lower limb with no systemic manifestations. There was no discharge and bullae from the swelling area of the leg. He had high blood sugar and was newly diagnosed with type 2 diabetes mellitus. He was diagnosed with necrotizing fasciitis. An intravenous imipenem-cilastatin 500 mg every 6 h together with clindamycin 900 mg every 8 h was started empirically. Extensive wound debridement was performed. The swab culture obtained intraoperatively grew He required an above knee amputation due to worsening infection despite wound debridement. Post-operatively, he developed acute kidney injury with severe metabolic acidosis, which required daily hemodialysis. However, the patient deteriorated due to septic shock with multi-organ failure, resulting in his death.

摘要

我们报告一例26岁病态肥胖男性的病例研究,其右腿疼痛和肿胀已有三天病史。肿胀伴有低热。他入院时神志清醒。体格检查显示整个右下肢明显肿胀,无全身表现。腿部肿胀部位无渗液和水疱。他血糖高,新诊断为2型糖尿病。他被诊断为坏死性筋膜炎。经验性开始静脉滴注亚胺培南 - 西司他丁500毫克,每6小时一次,同时克林霉素900毫克,每8小时一次。进行了广泛的伤口清创术。术中采集的拭子培养物生长出……尽管进行了伤口清创术,但由于感染恶化,他需要进行膝上截肢。术后,他出现了急性肾损伤并伴有严重代谢性酸中毒,需要每日进行血液透析。然而,患者因感染性休克伴多器官功能衰竭而病情恶化,最终死亡。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ff74/7649619/ac928eeb6b2e/gr1.jpg

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