Piwowarski Summer B, McGehee Michael W, White Derek W
Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Family Medicine, Ballad Health, Abingdon, USA.
Cureus. 2024 Sep 4;16(9):e68649. doi: 10.7759/cureus.68649. eCollection 2024 Sep.
Necrotizing fasciitis is a severe, life-threatening disease with a nonspecific clinical presentation, making it a challenging diagnosis. Early treatment with broad-spectrum antibiotics and surgical debridement is crucial to prevent rapid disease progression and poor outcomes. Given its high mortality rate and ambiguous presentation, maintaining a high index of suspicion for necrotizing fasciitis is essential. In this case, a 60-year-old woman presented to her gynecologist with urinary tract infection symptoms of frequency, hematuria, and suprapubic pain, with a year-long history of night sweats, hematuria, dysuria, and incomplete voiding. Although initially treated with outpatient antibiotics, she returned to the emergency department one day later with severe lower abdominal pain, overlying erythema, and a high fever. Abdominal imaging revealed extensive cellulitis. Upon the development of rapidly expanding erythema and crepitus, there was concern for necrotizing fasciitis. The patient received immediate treatment with broad-spectrum antibiotics and underwent urgent surgical debridement. While she showed clinical improvement in the following days, laboratory studies revealed profound hypercalcemia, anemia, and persistent leukocytosis. Additional testing ultimately led to the diagnosis of advanced bladder cancer. This case underscores the importance of prompt recognition and treatment of necrotizing fasciitis. It also highlights the influence of confirmation and availability biases, which can lead to overlooking symptoms that may indicate more serious underlying conditions. As medical professionals, it is crucial to remain vigilant and not disregard seemingly insignificant symptoms, as they could be indicative of life-threatening diagnoses.
坏死性筋膜炎是一种严重的、危及生命的疾病，临床表现不具有特异性，因此诊断具有挑战性。早期使用广谱抗生素和手术清创对于防止疾病快速进展和不良预后至关重要。鉴于其高死亡率和不明确的表现，对坏死性筋膜炎保持高度怀疑指数至关重要。在本病例中，一名60岁女性因尿频、血尿和耻骨上疼痛等尿路感染症状就诊于妇科医生，有长达一年的盗汗、血尿、排尿困难和排尿不尽病史。尽管最初在门诊接受了抗生素治疗，但一天后她因严重的下腹部疼痛、皮肤红斑和高热返回急诊科。腹部影像学检查显示广泛的蜂窝织炎。在迅速扩大的红斑和皮下气肿出现后，怀疑为坏死性筋膜炎。患者立即接受了广谱抗生素治疗并接受了紧急手术清创。虽然她在接下来的几天里临床症状有所改善，但实验室检查显示有严重的高钙血症、贫血和持续的白细胞增多。进一步检查最终确诊为晚期膀胱癌。本病例强调了及时识别和治疗坏死性筋膜炎的重要性。它还突出了确认偏差和可得性偏差的影响，这可能导致忽视可能表明更严重潜在疾病的症状。作为医学专业人员，保持警惕且不忽视看似微不足道的症状至关重要，因为它们可能预示着危及生命的诊断。
