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Alzetani S, Harden S, Alzetani A. An unexpected case of thoracic necrotising fasciitis. BMJ Case Rep 2024; 17:e257946. [PMID: 38296508 PMCID: PMC10831425 DOI: 10.1136/bcr-2023-257946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Necrotising fasciitis (NF) is a life-threatening bacterial infection characterised by rapid tissue destruction, which can have severe consequences if not recognised early and treated promptly. It is most commonly caused by group A streptococcus entering the body through breaks in the skin. This case report describes a patient who presented with systemic signs of infection, including right axillary pain, following a recent intramuscular injection. Clinical examination and radiological findings were consistent with NF, and surgical exploration confirmed the diagnosis of thoracic NF. The patient underwent extensive surgical debridement, intensive care management and subsequent reconstructive surgery. This report highlights the importance of early recognition of NF and that this condition is not limited to the limbs but may also affect the torso. It employs consideration of all portals of potential bacterial entry that may prompt a differential of NF through thorough history taking. This case encourages healthcare professionals to maintain awareness of skin infections as a potential though rare complication of procedures such as injections hence the continued value of aseptic techniques to minimise risk. Finally, it emphasises that prompt diagnosis, appropriate antibiotic therapy and immediate surgical intervention remain crucial in managing NF and improving patient outcomes.
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Affiliation(s)
- Sarah Alzetani
- Salisbury District Hospital NHS Foundation Trust, Salisbury, UK
| | - Stephen Harden
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aiman Alzetani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Das A, Dasgupta R. A case of Klebsiella pneumoniae hypervirulent phenotype causing necrotizing fasciitis of chest wall: A mono-microbial entity emerging in the Indian subcontinent. J Family Med Prim Care 2022; 11:376-378. [PMID: 35309676 PMCID: PMC8930121 DOI: 10.4103/jfmpc.jfmpc_1023_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022] Open
Abstract
Necrotizing fasciitis of the chest wall or upper torso is a rare clinical entity. Monomicrobial Klebsiella pneumoniae as a causative agent of necrotizing fasciitis is far less common than the polymicrobial etiology. Here, we report a case of community-onset pyogenic necrotizing fasciitis caused by Klebsiella pneumoniae in an immunocompetent male of tribal background from the rural area of Jharkhand, India. The hypermucoviscous phenotype of the bacterium causing necrotizing fasciitis has been infrequently reported from the Indian subcontinent to date. The existence of multidrug resistant trait in the hypervirulent pathotype poses a unique challenge in treatment in such a case and emerges as a critical community health problem requiring prompt attention of the public health stakeholders. Thus, there is a need for widespread awareness for proper protocols in antimicrobial usage, infection control, early diagnosis, and prompt treatment.
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Petreanu CA, Constantin T, Iosifescu R, Gibu A, Zariosu A, Croitoru A. Necrotizing fasciitis of the chest wall: A clinical case report and literature review. Exp Ther Med 2022; 23:90. [PMID: 34934455 PMCID: PMC8652382 DOI: 10.3892/etm.2021.11013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 11/08/2022] Open
Abstract
Necrotizing fasciitis of the chest wall is a very rare pathology, but with significant mortality, representing a therapeutic challenge. All international reports indicate the need for early diagnosis and an aggressive medical-surgical attitude in order to improve the prognosis. In addition to a review of literature, we present a case developed secondary to a thoracic pleural drainage for pyopneumothorax associated with significant bronchopleural fistula in a destroyed tuberculous left lung. Along with medical treatment, extensive surgical debridement was required. Despite drainage incisions and negative pressure wound therapy (NPWT), the evolution of the fasciitis was difficult, due to bronchopleurocutaneous fistula. Thus, the Azorin procedure (transcervical mediastinoscopic closure of the left main bronchus) was performed. Once this procedure was completed, the inflammatory phenomena were controlled which allowed for a second step consisting of left pneumonectomy, with the application of specific methods for the prevention of bronchial fistula. The clinical case was a therapeutic challenge requiring a complex, staged, multidisciplinary approach due to both the immunocompromised terrain and the severity of the lesions. In conclusion, early recognition and aggressive and combined application of medical and surgical treatment methods can ensure therapeutic success.
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Affiliation(s)
- Cornel Adrian Petreanu
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
- Department of Thoracic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Traian Constantin
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 061344 Bucharest, Romania
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Razvan Iosifescu
- Department of General Surgery, ‘Sf. Ioan’ Clinical Emergency Hospital, 042122 Bucharest, Romania
- Department of General Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandru Gibu
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
| | - Alexandru Zariosu
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
| | - Alina Croitoru
- Department of Pneumology, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
- Department of Pneumology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Unusual cases of necrotizing fasciitis: a clinical experience from Turkey. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1310-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Taneja V, Walker RJ, Tedla M. Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1266636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Virangna Taneja
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rachel J. Walker
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Miroslav Tedla
- Otorhinolaryngology Department, Warwick University and University Hospital Coventry, Coventry, UK
- Department of ORL-HNS, Faculty of Medicine, Comenius University Bratislava, Slovakia
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Nonodontogenic Cervical Necrotizing Fasciitis Caused by Sialadenitis. Case Rep Otolaryngol 2016; 2016:9520516. [PMID: 27822398 PMCID: PMC5086371 DOI: 10.1155/2016/9520516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022] Open
Abstract
Necrotizing fasciitis is a rapidly progressive infectious disease of the soft tissue with high mortality and morbidity rates. Necrotizing fasciitis is occasionally located in the head and neck region and develops after odontogenic infections. Factors affecting treatment success rates are early diagnosis, appropriate antibiotic treatment, and surgical debridement. We present a necrotizing fasciitis case located in the neck region that developed after sialoadenitis. It is important to emphasize that necrotizing fasciitis to be seen in the neck region is very rare. Nonodontogenic necrotizing fasciitis is even more rare.
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Rabiou S, Lakranbi M, Issoufou I, Ammor FZ, Belliraj L, Ouadnouni Y, Smahi M. [About two cases of primitive necrotizing fasciitis of the chest wall]. Rev Mal Respir 2016; 33:401-4. [PMID: 26810151 DOI: 10.1016/j.rmr.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Necrotizing fasciitis is a severe bacterial necrotic infection that affects the skin and soft tissues. OBSERVATION We report a rare observation of necrotizing fasciitis located at the thoracic wall. The management requires an appropriate antibiotherapy preceding a large necrosectomy taking all the affected areas, thus preparing the underlying tissues for a possible skin graft. CONCLUSION Through these two observations and a literature review, we describe the medical and surgical management of necrotizing fasciitis.
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Affiliation(s)
- S Rabiou
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc.
| | - M Lakranbi
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc
| | - I Issoufou
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc
| | - L Belliraj
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique C(1), CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
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Fatal Necrotizing Fasciitis in a Child following a Blunt Chest Trauma. Case Rep Pediatr 2013; 2013:373712. [PMID: 23607028 PMCID: PMC3623462 DOI: 10.1155/2013/373712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/11/2013] [Indexed: 11/17/2022] Open
Abstract
Necrotizing fasciitis is a serious soft tissue infection rarely occurring in children after blunt trauma. Due to its high morbidity and mortality rates, a high index of suspicion is necessary for prompt diagnosis and treatment. We describe a 6-year-old Costa Rican girl who died secondary to multiple complications following a posttraumatic necrotizing fasciitis.
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Blasberg JD, Donington JS. Infections and Radiation Injuries Involving the Chest Wall. Thorac Surg Clin 2010; 20:487-94. [DOI: 10.1016/j.thorsurg.2010.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Smahi M, Lakranbi M, Tazi N, Oufkir A. [Necrotizing fasciitis of the chest wall]. ANN CHIR PLAST ESTH 2010; 55:603-5. [PMID: 20646820 DOI: 10.1016/j.anplas.2010.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
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Birnbaum DJ, D'Journo XB, Casanova D, Thomas PA. Necrotizing fasciitis of the chest wall. Interact Cardiovasc Thorac Surg 2010; 10:483-4. [DOI: 10.1510/icvts.2009.222323] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Tata MD, Kwan KC, Abdul-Razak MR, Paramalingam S, Yeen WC. Adjunctive Use of Superoxidized Solution in Chest Wall Necrotizing Soft Tissue Infection. Ann Thorac Surg 2009; 87:1613-4. [DOI: 10.1016/j.athoracsur.2008.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 10/06/2008] [Accepted: 10/10/2008] [Indexed: 10/20/2022]
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Konstantinov IE, Saxena P, Shehatha J, Mitchell A, Cherian S. Novel Aeration Technique for Necrotizing Fasciitis of the Chest Wall. Ann Thorac Surg 2008; 86:1973-4. [DOI: 10.1016/j.athoracsur.2008.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 04/26/2008] [Accepted: 05/05/2008] [Indexed: 12/01/2022]
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Necrotizing fasciitis of the chest wall with a retropharyngeal abscess: case report and literature review. Ann Plast Surg 2008; 61:544-8. [PMID: 18948783 DOI: 10.1097/sap.0b013e31816d81ff] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We herein report a case of a diabetic 49-year-old woman with anterior chest wall necrotizing fasciitis that caused a retropharyngeal abscess and discuss the literature surrounding necrotizing soft tissue infections of the chest wall. The patient was treated with serial wound debridements, antibiotic therapy, and percutaneous drainage and serial irrigation of the retropharyngeal abscess with a silicone catheter. The resulting defect was grafted with a split thickness skin graft.
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Lu MS, Chen CM, Huang YK, Liu YH, Kao CL. Devastating chest wall necrotizing fasciitis following pigtail catheter drainage. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rmedc.2007.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Praba-Egge AD, Lanning D, Broderick TJ, Yelon JA. Necrotizing Fasciitis of the Chest and Abdominal Wall Arising from an Empyema. ACTA ACUST UNITED AC 2004; 56:1356-61. [PMID: 15211151 DOI: 10.1097/01.ta.0000042157.00868.2e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anita D Praba-Egge
- Department of Surgery, Evans-Haynes Burn Center, Divisions of General and Burn Surgery, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond, Virginia, USA
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Losanoff JE, Richman BW, Jones JW. Necrotizing soft tissue infection of the chest wall. Ann Thorac Surg 2002; 73:1694-5; author reply 1695. [PMID: 12022595 DOI: 10.1016/s0003-4975(02)03453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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