Bullock Travis S, Jodoin Zachary, Ornell Samuel S, Morton-Gonzaba Nicolas A, Karia Ravi A, Martin Case W
UT Health San Antonio, Department of Orthopaedics, San Antonio, TX 78229.
UT Health San Antonio, Department of Internal Medicine, San Antonio, TX 78229.
J Orthop Case Rep. 2025 Jun;15(6):190-196. doi: 10.13107/jocr.2025.v15.i06.5712.
It is well known that diabetic patients have impaired wound healing, increased susceptibility to infection, and harbor tissue that supports the growth of gas-producing infections. Necrotizing fasciitis (NF) is an uncommon soft-tissue infection characterized by extensive necrosis of subcutaneous tissue and fascia with relative sparing of the skin and muscle tissues. The majority of gas-producing infections are polymicrobial in nature, and therefore, NF with Staphylococcus aureus as a single etiologic agent is exceedingly uncommon.
This is a case of a 46-year-old male that developed gas-forming NF and abscesses from methicillin-sensitive S. aureus (MSSA) after a complicated course involving undiagnosed type 2 diabetes mellitus (T2DM), diabetic ketoacidosis, and bacteremia. The disease course presented relatively slowly with mild systemic symptoms, knee pain, erythema, and edema, but steadily progressed over days leading to an elevated level of care. Multidisciplinary care was necessary to treat the patient, including surgical and intravenous antibiotic therapies. The patient's care was prolonged due to decreased patient compliance with recommended therapies and difficulty with appropriate shared decision-making.
Although NF caused by monomicrobial infection with methicillin-resistant S. aureus has been previously reported, awareness of this condition remains limited, especially with concomitant gas formation. Physicians should have a high index of suspicion for NF with MSSA as a potential etiologic agent when treating patients with symptoms of a necrotizing soft-tissue infection, particularly those with underlying T2DM or a history of recent needle puncture. By engaging in shared decision making, health outcomes in these serious infections can be optimized.
众所周知，糖尿病患者伤口愈合受损，感染易感性增加，且其组织利于产气感染的生长。坏死性筋膜炎（NF）是一种罕见的软组织感染，其特征为皮下组织和筋膜广泛坏死，而皮肤和肌肉组织相对 spared。大多数产气感染本质上是多微生物感染，因此，由金黄色葡萄球菌作为单一病原体引起的NF极为罕见。
这是一例46岁男性病例，在经历了未确诊的2型糖尿病（T2DM）、糖尿病酮症酸中毒和菌血症的复杂病程后，发生了由甲氧西林敏感金黄色葡萄球菌（MSSA）引起的产气性NF和脓肿。病程进展相对缓慢，伴有轻度全身症状、膝关节疼痛、红斑和水肿，但数天内病情稳步进展，导致护理级别提高。治疗该患者需要多学科护理，包括手术和静脉抗生素治疗。由于患者对推荐治疗的依从性降低以及难以进行适当的共同决策，患者的护理时间延长。
虽然此前已有由耐甲氧西林金黄色葡萄球菌单微生物感染引起NF的报道，但对此病的认识仍然有限，尤其是伴有气体形成时。在治疗有坏死性软组织感染症状的患者时，尤其是那些患有潜在T2DM或近期有针刺史的患者，医生应对以MSSA为潜在病原体的NF保持高度怀疑。通过参与共同决策，可以优化这些严重感染的健康结局。
