Necrotizing fasciitis following intra-articular steroid injection: case report and review of the literature

Ten-year follow-up of a case of necrotizing fasciitis successfully treated with negative-pressure wound therapy, dermal regeneration template application, and split- thickness skin autograft

INTRODUCTION

Necrotizing fasciitis is a rapidly progressive and often fatal infection of the fasciae and subcutaneous tissues.

PATIENT AND METHODS

In this case report, we present the treatment of a 63-year-old patient suffering from diabetes mellitus, who was admitted to the emergency unit for severe right gluteal pain, which had begun 24 hours before admission. Cutaneous symptoms, oliguria, metabolic acidosis, acute renal failure, severe hypotension, and tachycardia occurred, and the patient was admitted to Intensive Care a few hours after initial admission. The patient underwent a debridement of gluteal, abdominal, lower-thoracic, and upper thigh regions. Biopsy of fascia lata confirmed the suspected diagnosis of necrotizing fasciitis. Treatment included prompt surgical debridement, negative-pressure wound therapy, and dermal regeneration template application with fibrin glue, and subsequent split-thickness skin autografting.

RESULTS

After 10 years, elasticity of the skin and limb mobility are comparable to that in non-injured areas, and the patient is pain free.

CONCLUSION

In our opinion, this combination should be a treatment of choice for large wounds in the patients with NF with multiple comorbidities.

A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report

Introduction. Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011). In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011). Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site. Conclusion. We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.