Rogers Patrick J, Lewis Brent M, Odak Mihir, Bucher Joshua
Emergency Medicine, Jersey Shore University Medical Center, Neptune City, USA.
Emergency Medicine, Community Medical Center, Toms River, USA.
Cureus. 2020 Dec 3;12(12):e11880. doi: 10.7759/cureus.11880.
Necrotizing soft tissue infections typically begin with direct inoculation of bacteria into the subcutaneous tissues. Here, we present a case with no such exposure, but with severe necrotizing fasciitis. We present a middle-aged man presented to the emergency department for a presumed allergic reaction after having initially sought care twice at an urgent care facility. The patient had swelling, but no tenderness of his right lateral chest and flank. Subsequent imaging showed extensive fluid in the fascial planes of the right chest wall requiring surgical debridement. Necrotizing fasciitis that is not treated with surgical debridement carries a mortality rate approaching 100%. This case highlights a potential atypical presentation as well as highlights the fact that the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score lacks sensitivity to rule out a necrotizing soft tissue infection, requiring surgical debridement for diagnosis.
坏死性软组织感染通常始于细菌直接接种到皮下组织。在此，我们报告一例没有此类暴露史，但患有严重坏死性筋膜炎的病例。我们介绍一名中年男性，他最初在紧急护理机构就诊两次后，因疑似过敏反应而被送往急诊科。患者右侧胸壁和侧腹肿胀，但无压痛。随后的影像学检查显示右胸壁筋膜平面有大量积液，需要手术清创。未经手术清创治疗的坏死性筋膜炎死亡率接近100%。该病例突出了一种潜在的非典型表现，同时也突出了坏死性筋膜炎实验室风险指标（LRINEC）评分在排除坏死性软组织感染方面缺乏敏感性这一事实，需要手术清创来进行诊断。
