Becker Deborah K, Röder Meike, Wagenhäuser Johannes, Eichberger Sebastian, Herten Monika, Dudda Marcel
Department of Trauma Surgery and Orthopedics, BG Klinikum Duisburg, University Duisburg-Essen, Germany.
Department of Radiology, BG Klinikum Duisburg, University Duisburg-Essen, Germany.
J Int Med Res. 2024 Dec;52(12):3000605241290480. doi: 10.1177/03000605241290480.
Necrotizing fasciitis (NF) is a rapidly progressing condition with a high mortality rate. The poor prognosis is often due to delayed diagnosis, which is typically made clinically or radiologically. This case report highlights a rare instance of fulminant NF with an atypical presentation-no initial clinical signs and an unusual radiological appearance. Both the localization and microbiological findings (non-resistant ) were uncommon for NF. The patient presented with no suspicious skin changes, pain, or medical history indicative of NF. A computed tomography scan revealed entrapped air, a pathognomonic sign of NF; however, the air was predominantly located in the abdomen, leading to an initial suspicion of hollow organ perforation because this is an unusual location for NF. Subsequently, NF was suspected based on the computed tomography findings combined with laboratory results. Despite prompt surgical intervention and broad-spectrum antibiotic therapy, the patient died of multi-organ failure within 16 hours. This case underscores the importance of recognizing the subtle and varied presentations of NF and using tools such as the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. Healthcare providers must maintain a high index of suspicion for NF, even when clinical, radiological, and laboratory findings seem inconspicuous.
坏死性筋膜炎（NF）是一种进展迅速、死亡率高的疾病。预后不良往往是由于诊断延迟，通常通过临床或影像学检查做出诊断。本病例报告突出了一例暴发性NF的罕见病例，其表现不典型——最初没有临床症状，影像学表现也不寻常。NF的发病部位和微生物学检查结果（无耐药性）均不常见。患者没有可疑的皮肤变化、疼痛或提示NF的病史。计算机断层扫描显示有积气，这是NF的一个特征性表现；然而，积气主要位于腹部，这导致最初怀疑是中空器官穿孔，因为这在NF中是一个不寻常的部位。随后，根据计算机断层扫描结果结合实验室检查结果怀疑为NF。尽管及时进行了手术干预并给予了广谱抗生素治疗，但患者在16小时内死于多器官功能衰竭。本病例强调了认识NF细微和多样表现以及使用坏死性筋膜炎实验室风险指标（LRINEC）评分等工具的重要性。医疗保健提供者即使在临床、影像学和实验室检查结果看似不明显时，也必须对NF保持高度的怀疑指数。
