Necrotizing fasciitis resulting from Streptococcus pneumoniae in recently diagnosed systemic lupus erythematosus case: a case report

Necrotizing fasciitis and meningitis due to Streptococcus pneumoniae serotype 9 N: a case report

Background

Necrotizing fasciitis is a deep infection of the fascia and subcutaneous tissue with a high mortality rate. Meningitis is an infection of the membranes surrounding the brain with a likewise high mortality rate. Streptococcus pneumoniae is the most frequent cause of bacterial meningitis and it is an extremely rare cause of necrotizing fasciitis. Different subcapsular serotypes of S. pneumoniae are known to have diverse virulence. The serotype 9 N is associated with a high risk of death.

Case presentation

We report a case of a previously healthy 68-year-old female who presented at our clinic with complaints of pain in her left calf since having experienced a very painful leg cramp 3 weeks prior. Within a few hours after admission, she developed fever, neck stiffness and an altered mental state. Concurrently, the pain in her leg worsened. Upon further examination it was found that she suffered from both meningitis and necrotizing fasciitis due to S. pneumoniae, serotype 9 N. The patient survived and avoided leg amputation.

Conclusions

The patient suffered from two very lethal infections simultaneously. Both of them were caused by S. pneumoniae. We believe that her favorable outcome was, a result of prompt surgical intervention and appropriate antibiotic treatment. Our case underlines the importance of continuous reevaluation of the symptoms and clinical findings in patients with unclear causes of severe illness, especially if the patient’s condition changes.

Case Report of Necrotizing Fasciitis Associated with Streptococcus pneumoniae

Necrotizing fasciitis, caused by Streptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated with Streptococcus pneumoniae infection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive for Streptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting from Streptococcus pneumoniae diagnosed at early phase; the patient recovered well without surgical debridement.

Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus

Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory.

Necrotising fasciitis in systemic lupus erythematosus: a case report and literature review

Necrotising fasciitis (NF) is a rare infection of the subcutaneous tissue, known to be rapidly progressive and potentially fatal. Patients with systemic lupus erythematosus (SLE) may be predisposed to this condition, and early clinical recognition can be difficult. We report a case of necrotising fasciitis in a 26-year-old woman with SLE. She presented with painful swelling of her left leg, then developed clinical features of septic shock. Emergency debridement was performed. Intraoperative findings revealed NF and cultures grew Pseudomonas aeruginosa. The patient survived after a lengthy hospital admission, following several further debridements complicated by recurrent chest sepsis and multiorgan failure. We also review and discuss the published cases of NF in SLE patients.

A case of necrotizing fasciitis due to Streptococcus pneumoniae serotype 5 in Saskatchewan

Necrotizing fasciitis due to Streptococcus pneumoniae is a rare and grave condition, and only a few cases have been reported. Suggested risk factors include minor trauma, systemic lupus erythematosus, immunosuppression secondary to medication, use of intramuscular anti-inflammatories and alcoholism. A fatal case of pneumococcal necrotizing fasciitis that occurred in a 51-year-old woman with a history of alcohol abuse and oral anti-inflammatory use is presented. Her condition was caused by a multi-etiology outbreak of community-acquired pneumonia, from which S pneumoniae serotype 5 was also isolated. The case description outlines the subtle presentation and rapid clinical progression of this condition. Because serotype 5 antigen is included in the polysaccharide 23-valent pneumococcal vaccine, the present case highlights the importance of pneumococcal immunization programs in Canada.

Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

Necrotizing fasciitis due to Streptococcus pneumoniae in a healthy 68-year old man: case report and review of the literature

A case of pneumococcal necrotizing soft-tissue infection (NSTI) is described and 16 cases available in literature are reviewed. Pneumococcal NSTI seems to be the consequence of hematogeneous shedding of pneumococci, with frequent involvement of articulations. Furthermore, pneumococcal NSTI present like other NSTI, with a high mortality and the need for a combined surgical and medical therapy.

Necrotizing Fasciitis in Systemic Lupus Erythematosus

OBJECTIVES

Necrotizing fasciitis (NF) is an uncommon infection of the subcutaneous tissue and superficial fascia. Any delay in treatment can lead to catastrophic results with high mortality. It is well known that patients with systemic lupus erythematosus (SLE) are at increased risk of infection, from the disease and/or its treatment. The objective of our study was to evaluate the presenting features of NF in SLE patients and to identify possible risk factors for this severe complication.

METHODS

We searched for patients with diagnoses of SLE and NF using a computerized patient database at Montefiore Medical Center (MMC), from 1996 to present. We also included patients from the MMC Lupus Clinic with these diagnoses (identified from paper records) from 1994 to present. Of a total of 449 patients with SLE that were followed during this time, 8 patients with NF were identified, and their records were reviewed.

RESULTS

Two of the 8 patients (25%) died during hospitalization. A third patient died within 2 months of hospital discharge. All 8 patients were receiving steroids at the time of diagnosis, and 7 of 8 had hypoalbuminemia and lymphopenia. Both patients who died in the hospital and the one patient who died within 2 months of her discharge had lupus nephritis.

CONCLUSIONS

NF is an uncommon infection, but one that must be recognized early if the outcome is to be favorable. This series of 8 cases of NF in SLE from a single institution suggests that heightened awareness is warranted, particularly among SLE patients who are immunosuppressed by virtue of their underlying disease, the therapy they require, or both.