1
|
Johnson R, Harsha P M F, Raipuria AK, Kumari S, Shiuli. Necrotizing Fasciitis: When skin confuses - An autopsy case report. J Forensic Leg Med 2024; 105:102715. [PMID: 38996744 DOI: 10.1016/j.jflm.2024.102715] [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] [Received: 03/30/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
Necrotizing Fasciitis (NF) is a severe life-threatening soft tissue infection characterized by the rapid destruction of muscle, fat and fascial layers. This report details an autopsy case report of a 40year old male, unclaimed body lacking the complete history except that given by the Police personnel accompanying in which there is no prior history of trauma. This person succumbed to septic shock secondary to NF, despite clinical interventions. This case emphasizes the importance of early diagnosis and the need for heightened clinical awareness to improve patient outcomes.
Collapse
Affiliation(s)
- Renjini Johnson
- Department of Forensic Medicine and Toxicology, King George's Medical University, Lucknow, India.
| | - Fathima Harsha P M
- Department of Forensic Medicine and Toxicology, King George's Medical University, Lucknow, India
| | - Anup Kumar Raipuria
- Department of Forensic Medicine and Toxicology, King George's Medical University, Lucknow, India
| | - Sangeeta Kumari
- Department of Forensic Medicine and Toxicology, King George's Medical University, Lucknow, India
| | - Shiuli
- Department of Forensic Medicine and Toxicology, King George's Medical University, Lucknow, India
| |
Collapse
|
2
|
Necrotizing Fasciitis: a Clinical Case and a Review of the Literature. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2021. [DOI: 10.2478/sjdv-2020-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Necrotizing fasciitis is a soft tissue, life-threatening infection with a fulminant and often fatal course. Early diagnosis is usually delayed as the onset of the disease is often masked in the form of erysipelas or cellulite. The condition is characterized by necrosis of the skin, subcutaneous tissue and underlying fascia. We describe a case of a 42-year-old man with a complaint of erythema, fever and severe pain in his right leg 4 days before hospitalization. The patient was admitted and treated with a diagnosis of erysipelas. A few hours after admission, in connection with a drastic deterioration in the general condition and dermatological status, he was transferred to a purulentseptic ward with a fulminant picture of necrotizing fasciitis. Debridement and fasciotomy were performed successfully and timely. Good prognosis and survival in patients with NF correlate directly with the complex of measures. Appropriate antibiotics and intensive general support avoid massive systemic diffusion. Early and adequate surgical debridement and fasciotomy are associated with improved survival.
Collapse
|
3
|
Suadoni F, Gioia S, Tiri B, Mencacci A, Vento S, Lancia M. A unique autopsy case of spontaneous necrotizing soft tissue infection of the chest-wall in a healthy adult without major risk factors. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2020. [DOI: 10.1016/j.fsir.2020.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
4
|
Karahan N, Oztermeli A. Subcutaneous emphysema or necrotizing fasciitis after insect bite? Trauma Case Rep 2020; 29:100353. [PMID: 32939391 PMCID: PMC7476870 DOI: 10.1016/j.tcr.2020.100353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background The rapid form of subcutaneous emphysema after an insect bite is hard to distinguish from necrotizing fasciitis. Case presentation Here we report a case of benign subcutaneous emphysema after an insect bite on the hand of an 18-year-old Caucasian man. The puncture area in the first web space of his hand was erythematous and swollen. After 4 h, he began to hear crackling sounds in the hand. Although conservative management was provided, he experienced gradually increasing pain and rapid progression in swelling and crepitation. The symptoms regressed after fasciotomy. Conclusion This is the fourth reported case of benign subcutaneous emphysema after an insect bite in the literature. Although benign emphysema has a good prognosis after treatment, it is similar to necrotizing fasciitis. Proper diagnosis can only be established with histological and microbiological investigations, but in cases where early histological and microbiological investigations cannot be performed, biochemistry and radiological test should be used.
Collapse
Affiliation(s)
- Nazım Karahan
- Corlu State Hospital, Orthopaedic and Traumatology, Bülent Ecevit Blv. No: 33, 59850 Çorlu, Tekirdağ, Turkey
- Corresponding author.
| | - Ahmet Oztermeli
- Gebze State Hospital, Osman Yılmaz, 1, İstanbul st. No: 127, 41400 Gebze, Kocaeli, Turkey
| |
Collapse
|
5
|
Abder-Rahman H, Habash I, Alami R, Alnimer T, Al-Abdallat I. Medico-legal importance of necrotizing fasciitis. J Forensic Leg Med 2020; 74:102019. [PMID: 32658769 DOI: 10.1016/j.jflm.2020.102019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/15/2022]
Abstract
Despite the rarity of necrotizing fasciitis (NF), it is a relatively common cause of death in many lawsuits. Families seek financial compensation or legal charges against those they believe to be involved in the death, usually physicians who did not identify the infection soon enough. This paper explores six cases in forensic pathology practice where NF posed a unique medico-legal dilemma.
Collapse
Affiliation(s)
- Hasan Abder-Rahman
- Forensic Pathology and Microbiology Department, University of Jordan, Amman, 11942, Jordan.
| | - Ibrahim Habash
- Forensic Pathology and Microbiology Department, University of Jordan, Amman, 11942, Jordan.
| | - Raghad Alami
- Ophthalmology Department, University of Jordan, Amman, 11942, Jordan.
| | - Touleen Alnimer
- Medical Student, University of Jordan, Amman, 11942, Jordan.
| | - Imad Al-Abdallat
- Forensic Pathology and Microbiology Department, University of Jordan, Amman, 11942, Jordan.
| |
Collapse
|
6
|
Hsueh SC, Huang YT, Hsueh PR. Streptococcus pyogenes cutaneous infection following sandfly bites. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:1000-1001. [PMID: 31607569 DOI: 10.1016/j.jmii.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Shun-Chung Hsueh
- Department of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Tsung Huang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
7
|
Jones BC, DuVal EH. Direct and indirect effects of the El Niño Southern Oscillation on development and survival of young of a tropical passerine. Oecologia 2019; 190:485-496. [DOI: 10.1007/s00442-019-04418-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/08/2019] [Indexed: 11/30/2022]
|
8
|
Wong RM, Chau LTC, Mak MCK, Tse WL, Ho PC. Necrotizing fasciitis induced by Vibrio vulnificus in patients without marine contact in Hong Kong. J Orthop Translat 2019; 19:151-154. [PMID: 31844623 PMCID: PMC6896480 DOI: 10.1016/j.jot.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/30/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Necrotizing fasciitis caused by Vibrio species is a life-threatening soft tissue infection with rapid progression and high mortality. The classic history of Vibrio species–induced necrotizing fasciitis is the infection of wounds by direct invasion or contact with contaminated seawater or raw seafood, especially in immunocompromised patients. We present two cases of Vibrio vulnificus necrotizing fasciitis in the upper limb without any wounds or seawater contact and with good past medical history. Both underwent timely surgical debridement and resulted with good functional outcome. Although rare, as clinicians, we need to have a high index of suspicion for the possibility of V. vulnificus necrotizing fasciitis despite no risk factors and give timely and appropriate treatment and, more importantly, patient survival.
Collapse
Affiliation(s)
- Ronald M.Y. Wong
- Corresponding author. Department of Orthopaedics and Traumatology, 5/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, N.T. Shatin, Hong Kong.
| | | | | | | | | |
Collapse
|
9
|
Paulis J, Tay ET. Necrotizing fasciitis with pulmonary septic emboli following an infected insect bite. Am J Emerg Med 2018; 36:2134.e3-2134.e4. [PMID: 30126671 DOI: 10.1016/j.ajem.2018.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 12/01/2022] Open
Abstract
Although systemic infections originating from skin infections caused by insect bites are uncommon, it is imperative to maintain a broad differential diagnosis should patients develop systemic symptoms. Necrotizing fasciitis is a rare diagnosis, and progression to septic pulmonary emboli is even less common. Emergent identification and aggressive treatment of these two disease processes are imperative as both carry high rates of morbidity and mortality.
Collapse
Affiliation(s)
- Jacqueline Paulis
- New York University School of Medicine, Department of Emergency Medicine, 462 First Ave, Suite A345, New York, NY 10016, United States of America
| | - Ee Tein Tay
- New York University School of Medicine, Department of Emergency Medicine, 462 First Ave, Suite A345, New York, NY 10016, United States of America.
| |
Collapse
|
10
|
Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy. Eur Arch Otorhinolaryngol 2018; 275:2555-2562. [DOI: 10.1007/s00405-018-5096-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
|
11
|
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.
Collapse
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
| |
Collapse
|