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. 2018 Apr 6;11(1):23.
doi: 10.1186/s12245-018-0183-x.

Necrotising fasciitis: a fatal case of sepsis and a diagnostic challenge - case report and review of literature

Lekha Agarwal  1 , Athar Yasin  2
Affiliations

Necrotising fasciitis: a fatal case of sepsis and a diagnostic challenge - case report and review of literature

Lekha Agarwal et al. Int J Emerg Med. .

Abstract

Background: Necrotising fasciitis (NF) is a severe, devastating soft tissue infection characterised by rapidly progressing tissue necrosis. This rare condition has a high mortality rate and poses diagnostic and management challenges to the clinician. There is usually a history of trauma, which maybe trivial. Some of the premorbid conditions associated with NF are diabetes and or immunocompromised state. It requires prompt recognition and early treatment with intravenous antibiotics and extensive surgical debridement.

Case presentation: We describe a 74-year-old lady who presented to our emergency department following 3 days' history of watery diarrhoea and feeling generally unwell. She had signs of severe sepsis and was started on broad-spectrum intravenous antibiotics and fluids for sepsis with unknown source. She was found to have an area of blackish discolouration on her thigh which was suspected as necrotising fasciitis (NF) and referred to the surgeons. She had no history of trauma or significant comorbidity. She underwent surgical exploration and debridement within few hours of arrival into the emergency department and subsequent further debridement with above-knee amputation of the affected limb. She eventually died after about 48 h of hospital stay despite an early diagnosis and prompt surgical debridement and a multidisciplinary approach.

Conclusions: Necrotising fasciitis has been previously reported in literature but we would like to highlight through this case the importance of looking for the source of sepsis by thorough clinical examination and the need to have a high threshold of suspicion for this rare condition and urgent involvement of a surgical team for debridement.

Keywords: Necrotising fasciitis; Rapid tissue necrosis; Sepsis; Soft tissue infection.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written consent was obtained from patient’s next of kin for publication of this case report and its accompanying images.

Competing interests

Both authors declare that they have no competing interest.

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Figures

Fig. 1
Fig. 1
Blackish discolouration with vesicle formation on the thigh
Fig. 2
Fig. 2
Per-operative image showing necrosis of muscle and soft tissue
Fig. 3
Fig. 3
Extent of necrotic tissue up to the pelvis on the second surgery
See this image and copyright information in PMC

References

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