Sakkab Ramez, MacRae Tyler, Nguyen Quynh Giao, Ballon-Landa Gonzalo
*Scripps Mercy Hospital, San Diego, CA.
J Am Podiatr Med Assoc. 2023 May-Jun;113(3). doi: 10.7547/22-113.
Necrotizing fasciitis is a devastating inflammatory infection requiring emergent medical treatment and surgical intervention. Even with timely management, the mortality rate of necrotizing fasciitis approaches 25%. The causative bacteria invade fascial planes and express toxins that advance rapidly. Here, we document a rare case of necrotizing fasciitis from Serratia marcescens infection. Serratia marcescens is capable of inducing a necrotizing inflammatory cascade mediated by extracellular cytotoxin and lipase. In this case report, a 90-year-old man presented to our emergency department from a long-term care facility with a relatively benign-appearing ulcer with surrounding cellulitis on the right ankle. Blood cultures and wound cultures confirmed the organism to be S marcescens. A multidisciplinary team was consulted for management. The patient received antibiotic therapy and medical support, but because of his comorbid conditions and social situation, the designated medical decision maker opted for comfort care rather than aggressive surgical debridement. The patient progressed through the clinical stages of necrotizing fasciitis. Within 36 hours, the patient died as result of sepsis-induced organ failure.
坏死性筋膜炎是一种极具破坏性的炎症感染，需要紧急医疗救治和手术干预。即便得到及时治疗，坏死性筋膜炎的死亡率仍接近25%。致病细菌侵入筋膜平面并释放迅速扩散的毒素。在此，我们记录了一例由粘质沙雷氏菌感染引起的罕见坏死性筋膜炎病例。粘质沙雷氏菌能够引发由细胞外细胞毒素和脂肪酶介导的坏死性炎症级联反应。在本病例报告中，一名90岁男性从长期护理机构送至我院急诊科，其右踝部有一个外观相对良性的溃疡，伴有周围蜂窝织炎。血培养和伤口培养证实病原体为粘质沙雷氏菌。我们咨询了一个多学科团队进行管理。患者接受了抗生素治疗和医疗支持，但由于其合并症和社会状况，指定的医疗决策者选择了舒适护理而非积极的手术清创。患者经历了坏死性筋膜炎的临床阶段。在36小时内，患者因脓毒症引发的器官衰竭死亡。
