Sharif Shahriar, Swaminath Samyukta, Mozumder Nashit, Mack Kenneth A, Marin Diego
Internal Medicine, HCA Florida Westside Hospital, Plantation, USA.
Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Cureus. 2024 Mar 8;16(3):e55807. doi: 10.7759/cureus.55807. eCollection 2024 Mar.
Necrotizing fasciitis is a rapidly progressing bacterial infection that affects the deep fascia and subcutaneous tissues, often resulting in tissue necrosis and systemic toxicity. This case involves a male in his late forties who initially sought emergency care for a minor rash on his right lower extremity and symptoms of a viral illness. Despite an initial diagnosis of hematoma, his symptoms rapidly escalated within 24 hours, prompting his return to the emergency room. During this subsequent visit, signs of septic shock emerged, accompanied by a worsening rash and blister formation. Admitted to the intensive care unit, our patient received urgent treatment, including broad-spectrum antibiotics and surgical debridement based on the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for assessing necrotizing fasciitis severity. Further debridement and a fasciotomy were performed, leading to improved clinical conditions, stabilized vitals, and normalized laboratory results. This case underscores the critical importance of early clinical suspicion, prompt diagnosis, and a collaborative, team-based approach in successfully managing necrotizing fasciitis.
坏死性筋膜炎是一种进展迅速的细菌感染,累及深筋膜和皮下组织,常导致组织坏死和全身中毒。该病例涉及一名四十多岁的男性,他最初因右下肢轻微皮疹和病毒感染症状寻求急诊治疗。尽管最初诊断为血肿,但他的症状在24小时内迅速恶化,促使他再次返回急诊室。在随后的这次就诊中,出现了感染性休克的迹象,同时皮疹恶化并形成水疱。患者被收入重症监护病房,接受了紧急治疗,包括根据坏死性筋膜炎实验室风险指标(LRINEC)评分使用广谱抗生素和进行外科清创,以评估坏死性筋膜炎的严重程度。进一步进行了清创和筋膜切开术,使临床状况得到改善,生命体征稳定,实验室检查结果恢复正常。该病例强调了早期临床怀疑、及时诊断以及采用协作性的团队治疗方法对成功治疗坏死性筋膜炎的至关重要性。