Toma Kenya, Ishiki Haruka, Oshiro Yusuke, Shinzato Takashi, Tokuda Yasuharu
Division of Infectious Diseases and General Internal Medicine, Nakagami General Hospital, Japan.
Intern Med. 2025 Mar 1;64(5):781-785. doi: 10.2169/internalmedicine.4021-24. Epub 2024 Jul 11.
Necrotizing fasciitis (NF) is a life-threatening disease with high mortality and rapidly progressive clinical manifestations. Early detection and surgical management coupled with antibiotic treatment are crucial for the survival, and the patient survival is heavily dependent on clinical decisions. However, it is not widely known that NF does not always follow a typical clinical course, and there have been no case reports of NF following an atypical clinical course. Although the course of the disease depends on the individual patient, it remains a challenge for physicians to determine the precise timing when patients are most likely to survive multiple surgical interventions. We encountered a challenging case presenting with an atypical clinical course. We herein report a 31 year-old man who followed a deteriorating biphasic-like clinical course and presented with extensive NF and streptococcal toxic shock syndrome due to Group A Streptococcus. This case serves to inform physicians of the existence of NF with an atypical and deteriorating biphasic-like clinical course, emphasizing the need for a careful evaluation of the patient condition.
坏死性筋膜炎（NF）是一种危及生命的疾病，死亡率高，临床表现迅速进展。早期发现、手术治疗以及抗生素治疗对患者生存至关重要，患者的生存很大程度上取决于临床决策。然而，NF并非总是遵循典型的临床病程，且尚无非典型临床病程的NF病例报告，这一点并不广为人知。尽管疾病进程因个体患者而异，但对于医生来说，确定患者最有可能在多次手术干预中存活的精确时机仍然是一项挑战。我们遇到了一例具有挑战性的非典型临床病程病例。在此，我们报告一名31岁男性，其临床病程呈双相恶化，因A组链球菌感染出现广泛的NF和链球菌中毒性休克综合征。该病例旨在告知医生存在非典型且呈双相恶化临床病程的NF，强调需要仔细评估患者病情。
