Chen Liying, Zhu Yinhui, Fan Du
Department of Respiratory Medicine, The Third Hospital of Changsha, Hunan, 410004, China.
Heliyon. 2023 Oct 6;9(10):e20733. doi: 10.1016/j.heliyon.2023.e20733. eCollection 2023 Oct.
We admitted a patient with extensive and rapidly progressing necrotizing fasciitis, pulmonary tuberculosis, cutaneous tuberculosis, and bacterial infections because of late diagnosis and treatment. Early diagnosis is necessary for both cutaneous tuberculosis and necrotizing fasciitis. However, these are rare clinical manifestations and are difficult to detect. Despite surgical and pharmacologic treatment, the patient had poor outcomes. We discussed the next-generation sequencing test for early tuberculosis diagnosis, especially for atypical ones. The modified and typical laboratory risk indicator for necrotizing fasciitis score was used for diagnosing and identifying patients at high risk for necrotizing fasciitis. Subcutaneous effusions and gas accumulations observed through imaging were useful in assessing necrotizing fasciitis progression. Debridement or tuberculosis treatment should be initiated as early as possible in managing patients with both necrotizing fasciitis and cutaneous tuberculosis. Clinicians should be alert in identifying the condition, whether tuberculosis is the independent cause of necrotizing fasciitis, and treating the condition. The choice of rapid microbial diagnostic tools should be of concern. Debridement or tuberculosis treatment should be initiated as early as possible in managing patients with both necrotizing fasciitis and cutaneous tuberculosis. Multidisciplinary cooperation should be considered.
由于诊断和治疗延迟，我们收治了一名患有广泛且迅速进展的坏死性筋膜炎、肺结核、皮肤结核和细菌感染的患者。皮肤结核和坏死性筋膜炎都需要早期诊断。然而，这些都是罕见的临床表现，难以检测。尽管进行了手术和药物治疗，患者的预后仍然很差。我们讨论了用于早期结核病诊断的下一代测序检测，特别是针对非典型结核病。改良的坏死性筋膜炎典型实验室风险指标评分用于诊断和识别坏死性筋膜炎高危患者。通过影像学观察到的皮下积液和气体积聚有助于评估坏死性筋膜炎的进展。在治疗坏死性筋膜炎和皮肤结核患者时，应尽早开始清创或结核病治疗。临床医生在识别病情、判断结核病是否为坏死性筋膜炎的独立病因以及治疗该病情时应保持警惕。应关注快速微生物诊断工具的选择。在治疗坏死性筋膜炎和皮肤结核患者时，应尽早开始清创或结核病治疗。应考虑多学科合作。
