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Fujita S, Hayashi H, Kodama S, Mukai T, Morita Y. Bacteremia Possibly Caused by Helicobacter cinaedi and Associated with Painful Erythema in Rheumatoid Arthritis with Malignant Lymphoma. Intern Med 2018; 57:3663-3666. [PMID: 30146580 PMCID: PMC6355406 DOI: 10.2169/internalmedicine.1196-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We herein report the case of a 69-year-old woman with rheumatoid arthritis (RA) and malignant lymphoma who developed Helicobacter cinaedi bacteremia after starting rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. She had a recurrent fever and painful erythema for 13 months before the diagnosis was made. This delayed diagnosis was attributable to the underlying RA, which typically presents with various cutaneous manifestations and elevated C-reactive protein levels. The erythema on the thighs, abdomen, and left forearm improved following treatment with intravenous aminobenzyl penicillin; she received antibiotics for six weeks. This case emphasizes the importance of recognizing this opportunistic infection in immunocompromised patients.
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Affiliation(s)
| | | | - Shoko Kodama
- Department of Rheumatology, Kawasaki Medical School, Japan
| | - Tomoyuki Mukai
- Department of Rheumatology, Kawasaki Medical School, Japan
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Fais P, Viero A, Viel G, Giordano R, Raniero D, Kusstatscher S, Giraudo C, Cecchetto G, Montisci M. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges. Int J Legal Med 2018; 132:1357-1366. [PMID: 29627916 DOI: 10.1007/s00414-018-1838-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/27/2018] [Indexed: 12/19/2022]
Abstract
Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.
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Affiliation(s)
- Paolo Fais
- Department of Medical and Surgical Sciences (DIMEC), Institute of Legal Medicine, University of Bologna, Bologna, Italy
| | - Alessia Viero
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy.
| | - Renzo Giordano
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Dario Raniero
- Department of Public Health and Community Medicine, Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
| | | | - Chiara Giraudo
- Institute of Radiology, Department of Medicine (DiMED), University-Hospital Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
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