Spontaneous Necrotizing Fasciitis

Necrotizing soft tissue infections typically begin with direct inoculation of bacteria into the subcutaneous tissues. Here, we present a case with no such exposure, but with severe necrotizing fasciitis. We present a middle-aged man presented to the emergency department for a presumed allergic react...

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Published inCurēus (Palo Alto, CA) Vol. 12; no. 12; p. e11880
Main Authors Rogers, Patrick J, Lewis, Brent M, Odak, Mihir, Bucher, Joshua
Format Journal Article
LanguageEnglish
Published United States Cureus 03.12.2020
Subjects
Infectious Disease
soft tissue infection
necrotizing fascitis
surgical debridement
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Summary:Necrotizing soft tissue infections typically begin with direct inoculation of bacteria into the subcutaneous tissues. Here, we present a case with no such exposure, but with severe necrotizing fasciitis. We present a middle-aged man presented to the emergency department for a presumed allergic reaction after having initially sought care twice at an urgent care facility. The patient had swelling, but no tenderness of his right lateral chest and flank. Subsequent imaging showed extensive fluid in the fascial planes of the right chest wall requiring surgical debridement. Necrotizing fasciitis that is not treated with surgical debridement carries a mortality rate approaching 100%. This case highlights a potential atypical presentation as well as highlights the fact that the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score lacks sensitivity to rule out a necrotizing soft tissue infection, requiring surgical debridement for diagnosis.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.11880