Yang Felix, Malavia Mira, Chali Ashna, Keeler Jared
Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Cureus. 2024 Feb 5;16(2):e53625. doi: 10.7759/cureus.53625. eCollection 2024 Feb.
A patient with comorbid diabetes mellitus, obesity, and hypertension acutely presented to the ED due to labial cellulitis with rapidly progressing symptoms of systemic inflammation. Clinical examination revealed fever and groin pain that was tender to palpation. Initial contrast-enhanced CT scans showed labial cellulitis extending to the inguinal canal, with later CT imaging findings of subcutaneous air indicative of necrotizing fasciitis (NF). Antimicrobial therapy was initiated empirically and later tailored to culture antibiogram. The patient underwent acute surgical abscess drainage and tissue debridement but was transferred to the surgical intensive care unit (SICU) due to postoperative blood loss and hypotension. Two additional surgical procedures were needed before sufficient drainage was achieved, and () was isolated from all samples. Due to the extent of the infection, the patient was admitted for a total of 16 days, with five days spent in the SICU. They recovered completely due to adequate surgery and antimicrobial therapy for a total of 24 days. Here, we present the third reported case of NF due to while emphasizing timely treatment with empiric antibiotics and surgical intervention.
一名患有糖尿病、肥胖症和高血压合并症的患者因唇部蜂窝织炎并伴有全身炎症快速进展的症状而急症就诊于急诊科。临床检查发现发热以及腹股沟疼痛,触诊时有压痛。初始的增强CT扫描显示唇部蜂窝织炎延伸至腹股沟管,后来的CT影像结果显示皮下气肿,提示为坏死性筋膜炎(NF)。经验性地开始抗菌治疗,之后根据培养药敏结果进行调整。患者接受了急性外科脓肿引流和组织清创术,但因术后失血和低血压被转入外科重症监护病房(SICU)。在实现充分引流之前还需要另外两次外科手术,并且从所有样本中分离出了()。由于感染范围,患者总共住院16天,其中5天在SICU。经过总共24天的充分手术和抗菌治疗,他们完全康复。在此,我们报告第三例因()导致的NF病例,同时强调经验性抗生素治疗和手术干预的及时性。