Post-procedural necrotizing fasciitis following femoral coronary angiography in patient with chronic endocarditis: A case report

Abstract

Background: Necrotizing fasciitis is a life-threatening soft tissue infection characterized by rapid tissue necrosis, often leading to sepsis and multisystem organ failure. Necrotizing fasciitis can rarely occur as a post-procedural complication, particularly following cardiac catheterization or angiography. This case report presents the clinical presentation and management of a 64-year-old female with a history of chronic endocarditis and valvular involvement who developed necrotizing fasciitis after femoral coronary angiography.

Case presentation: A 64-year-old female with a history of chronic endocarditis and valvular involvement underwent femoral coronary angiography as part of her cardiac evaluation. On the first postoperative day, the patient developed worsening pain, swelling, and redness in her right lower extremity, which worsened despite antibiotic therapy and pain management. The patient was diagnosed with necrotizing fasciitis. An emergent right lower extremity fasciotomy was performed to debride the necrotic tissue and release the tension caused by acute compartment syndrome.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for NF in patients with persistent soft tissue infection symptoms post-procedure. Early recognition, prompt diagnosis, and aggressive surgical intervention are crucial for the successful management of post-procedural NF following femoral coronary angiography. This report emphasizes the need for a multidisciplinary approach and vigilance in caring for patients to ensure optimal outcomes in such rare but severe complications.

Keywords: Compartment syndrome; Coronary angiography; Endocarditis; Fasciotomy; Necrotizing fasciitis.

Figure 1

appearance of the patient’s right thigh indicating ulceration and bullae

Figure 2

pelvic CT scan showed a large size hematoma in right thigh