Henry Reynold, McGillen Patrick, Nassiri Nima, Asanad Kian, Matsushima Kazuhide, Inaba Kenji, Clark Damon
Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA.
Department of Urology, University of Southern California, Los Angeles, CA, USA.
Am Surg. 2023 May;89(5):2101-2104. doi: 10.1177/00031348211031856. Epub 2021 Jul 8.
Necrotizing soft tissue infection (NSTI) is a rapidly progressive and often fatal infection of the soft tissue. Classically, it is attributed to bacterial infection and immunocompromised patients are particularly vulnerable. However, NSTI due to fungal infection rarely does occur, including from species, and can pose a diagnostic challenge for unfamiliar providers. Expedient clinical recognition, surgical debridement, fungal tissue culture, and initiation of antifungal therapy are key.
We report a 39-year-old obese male with long-standing history of poorly controlled diabetes who presented to a community hospital, noted to have NSTI of the sacrum, bilateral buttocks, and left hip, and was treated only with antibiotics. After transfer to an academic center, the patient underwent aggressive debridement and tissue diagnosis of NSTI was made. He received broad-spectrum antibiotic and antifungal therapy for several months. Over the course of 4 months, his infection was cleared, and his large tissue defects were reconstructed with rotation flaps and the patient was discharged home.
Fungal NSTI is a rare entity, especially when due to species. It can be exceedingly difficult to diagnose and manage, as these patients may suffer higher mortality than those with NSTI due to bacteria. A high index of suspicion for the entity, rapid debridement, intraoperative tissue culture, and treatment with appropriate antifungal therapy offers the greatest chance of survival.
坏死性软组织感染（NSTI）是一种进展迅速且常危及生命的软组织感染。传统上，它被认为是由细菌感染引起的，免疫功能低下的患者尤其易患。然而，由真菌感染引起的NSTI确实很少见，包括来自某些菌种，这可能给不熟悉的医疗人员带来诊断挑战。迅速的临床识别、手术清创、真菌组织培养以及启动抗真菌治疗是关键。
我们报告一名39岁的肥胖男性，有长期糖尿病控制不佳的病史，他到一家社区医院就诊，被发现患有骶骨、双侧臀部和左髋部的NSTI，最初仅接受了抗生素治疗。转至学术中心后，患者接受了积极的清创术，并对NSTI进行了组织诊断。他接受了数月的广谱抗生素和抗真菌治疗。在4个月的病程中，他的感染得以清除，其大面积的组织缺损通过旋转皮瓣进行了重建，患者随后出院回家。
真菌性NSTI是一种罕见的病症，尤其是由某些菌种引起时。它的诊断和管理可能极其困难，因为这些患者的死亡率可能高于细菌性NSTI患者。对该病症保持高度怀疑、快速清创、术中组织培养以及使用适当的抗真菌治疗提供了最大的生存机会。
