Department of Surgery, College of Medicine, Najran University, Najran, Saudi Arabia.
Am J Case Rep. 2024 Sep 15;25:e944186. doi: 10.12659/AJCR.944186.
BACKGROUND Necrotizing fasciitis is an aggressive type of skin and soft tissue infection that results in necrosis of subcutaneous tissues, including muscle and fascia. Mixed bacteria, including gas-forming organisms, are usually identified. This report describes a 55-year-old male diabetic patient with herpes zoster involving the thoracic dermatomes complicated by skin infection, necrotizing fasciitis, chest wall abscess, and sepsis. CASE REPORT A 55-year-old man with diabetes mellitus presented with thoracic herpes zoster, initially treated with acyclovir and topical agents. He developed swelling, pain, and fever over the left chest, which was unresponsive to topical treatment. Investigations revealed elevated white blood cells and gas on chest X-ray. Computed tomography confirmed a 13×6×11-cm abscess with gas between the latissimus dorsi and serratus anterior muscles, suggesting necrosis. He received intravenous amoxicillin/clavulanic acid and metronidazole and underwent urgent surgical drainage, yielding 200 mL of pus. Cultures identified antibiotic-sensitive Staphylococcus aureus and Clostridium perfringens. Histopathology confirmed necrotizing tissue with acute bacterial inflammation. He was treated postoperatively with dressings and vacuum-assisted closure, followed by sutures, and was discharged in good condition after 16 days. CONCLUSIONS This case underscores the aggressive nature and potential complications of necrotizing soft tissue infections in patients with diabetes mellitus and herpes zoster. Prompt recognition, early intervention with appropriate antibiotics, and surgical drainage are crucial in managing such infections effectively. The successful use of vacuum-assisted closure therapy underscores its role in facilitating wound healing after debridement. Clinicians should maintain vigilance for necrotizing infections in similar high-risk patients to ensure early intervention and improve clinical outcomes.
坏死性筋膜炎是一种侵袭性皮肤和软组织感染，可导致皮下组织（包括肌肉和筋膜）坏死。通常可鉴定出混合细菌，包括产气菌。本报告描述了 1 例 55 岁男性糖尿病患者，其胸背部带状疱疹并发皮肤感染、坏死性筋膜炎、胸壁脓肿和脓毒症。
1 例 55 岁男性糖尿病患者，因胸背部带状疱疹初始接受阿昔洛韦和局部治疗。他出现左侧胸部肿胀、疼痛和发热，局部治疗无效。检查发现白细胞升高和胸部 X 光上有气体。计算机断层扫描证实存在 13×6×11cm 的脓肿，在背阔肌和前锯肌之间有气体，提示坏死。他接受了静脉用阿莫西林/克拉维酸和甲硝唑治疗，并进行了紧急手术引流，获得 200ml 脓液。培养鉴定出对抗生素敏感的金黄色葡萄球菌和产气荚膜梭菌。组织病理学证实存在伴有急性细菌性炎症的坏死组织。他术后接受了敷料和真空辅助闭合治疗，随后进行缝合，16 天后状况良好出院。
本病例强调了糖尿病和带状疱疹患者中坏死性软组织感染的侵袭性和潜在并发症。及时识别、早期使用适当的抗生素和手术引流对于有效治疗此类感染至关重要。真空辅助闭合治疗的成功应用突显了其在清创后促进伤口愈合的作用。临床医生应密切关注类似高风险患者中的坏死性感染，以确保早期干预和改善临床结局。
