Heidelberg Laura S, Pettke Erica N, Wagner Teresa, Angotti Lauren
Swedish Colon and Rectal Clinic, Swedish Medical Center, Seattle, WA 98104, USA.
Department of Critical Care Medicine, Swedish Medical Group, Seattle, WA 98104, USA.
J Surg Case Rep. 2020 Nov 10;2020(11):rjaa371. doi: 10.1093/jscr/rjaa371. eCollection 2020 Nov.
Necrotizing fasciitis is an aggressive, life threatening soft tissue infection that requires high index of suspicion for diagnosis. Diagnosis is clinical with management including broad spectrum antibiotics and emergent operative debridement. The majority of cases are secondary to underlying medical processes, local tissue damage, abscess, or inciting procedure, with a paucity of data correlating causation with colon cancer. We describe the case of an 84-year-old man presenting with sepsis of unknown origin who was diagnosed with an atypical presentation of necrotizing fasciitis secondary to a perforated cecal malignancy. His case is unique in that a less virulent polymicrobial infection was likely involved as he initially improved with conservative management alone. He ultimately declined and expired secondary to overwhelming sepsis from his infection. This case highlights the importance of maintaining a high index of suspicion for necrotizing infection and considerations for alternative etiologies of infection including perforated malignancies.
坏死性筋膜炎是一种侵袭性、危及生命的软组织感染，诊断时需要高度怀疑。诊断依靠临床判断，治疗包括使用广谱抗生素和紧急手术清创。大多数病例继发于潜在的医疗过程、局部组织损伤、脓肿或诱发手术，与结肠癌相关的病因数据较少。我们描述了一名84岁男性患者的病例，该患者出现不明原因的败血症，被诊断为盲肠恶性肿瘤穿孔继发的坏死性筋膜炎非典型表现。他的病例独特之处在于，可能涉及毒性较低的混合微生物感染，因为他最初仅通过保守治疗就有所好转。他最终病情恶化，因感染导致的严重败血症而死亡。该病例强调了对坏死性感染保持高度怀疑的重要性，以及对包括恶性肿瘤穿孔在内的感染替代病因的考虑。
