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Turban A, Joussellin V, Piau C, Cattoir V, Launey Y, Eustache G. Fatal Clostridium septicum gas gangrene complicating ECMO: case report and review of literature. Access Microbiol 2024; 6:000825.v3. [PMID: 39104453 PMCID: PMC11299951 DOI: 10.1099/acmi.0.000825.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/21/2024] [Indexed: 08/07/2024] Open
Abstract
Clostridium septicum gas gangrene is a severe and deadly infection caused by an anaerobic, spore-forming, Gram-positive bacillus. As previously described, two entities are observed: traumatic and spontaneous (or non-traumatic) forms. In this report, we aim to describe the case of a fulminant and ultimately fatal C. septicum myonecrosis occurring in a patient who was first admitted for refractory cardiac arrest and placed on veino-arterial extracorporeal membrane oxygenation (ECMO). Building upon prior studies that have documented cases of spontaneous gas gangrene caused by C. septicum, we provide an updated compilation, focusing on microbiological characteristics of C. septicum, along with the diagnostic and therapeutic challenges associated with spontaneous gas gangrene. Additionally, the specific clinical situation of our case illustrates the seriousness of this infectious complication that combined both spontaneous and traumatic gas gangrene risk factors. We thus, discuss the antibiotic coverage prior to the initiation of ECMO procedure.
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Affiliation(s)
- Adrien Turban
- Department of Bacteriology, University Hospital of Rennes, 2 Rue Henri Le Guilloux, 35000 Rennes, France
| | - Vincent Joussellin
- Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France
| | - Caroline Piau
- Department of Bacteriology, University Hospital of Rennes, 2 Rue Henri Le Guilloux, 35000 Rennes, France
| | - Vincent Cattoir
- Department of Bacteriology, University Hospital of Rennes, 2 Rue Henri Le Guilloux, 35000 Rennes, France
- UMR_S 1230 BRM, Inserm/University of Rennes, 2 Avenue du Pr. Léon Bernard, 35000 Rennes, France
| | - Yoann Launey
- Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France
| | - Gabriel Eustache
- Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France
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Stojičić M, Jurišić M, Marinković M, Karamarković M, Jovanović M, Jeremić J, Jović M, Vlahović A, Jovanović M, Radenović K, Jovićević N, Vasović D. Necrotizing Fasciitis-Severe Complication of Bullous Pemphigoid: A Systematic Review, Risk Factors, and Treatment Challenges. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040745. [PMID: 37109703 PMCID: PMC10144771 DOI: 10.3390/medicina59040745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Bullous pemphigoid (BP), the most common subepidermal autoimmune skin blistering disease (AIBD) has an estimated annual incidence of 2.4 to 42.8 new cases per million in different populations, designating it an orphan disease. Characterized by disruption of the skin barrier combined with therapy-induced immunosuppression, BP could pose a risk for skin and soft tissue infections (SSTI). Necrotizing fasciitis (NF) is a rare necrotizing skin and soft tissue infection, with a prevalence of 0.40 cases per 100,000 to 15.5 cases per 100,000 population, often associated with immunosuppression. Low incidences of NF and BP classify them both as rare diseases, possibly contributing to the false inability of making a significant correlation between the two. Here, we present a systematic review of the existing literature related to the ways these two diseases correlate. Materials and methods: This systematic review was conducted according to the PRISMA guidelines. The literature review was conducted using PubMed (MEDLINE), Google Scholar, and SCOPUS databases. The primary outcome was prevalence of NF in BP patients, while the secondary outcome was prevalence and mortality of SSTI in BP patients. Due to the scarcity of data, case reports were also included. Results: A total of 13 studies were included, six case reports of BP complicated by NF with six retrospective studies and one randomized multicenter trial of SSTIs in BP patients. Conclusions: Loss of skin integrity, immunosuppressive therapy, and comorbidities commonly related to BP patients are risk factors for necrotizing fasciitis. Evidence of their significant correlation is emerging, and further studies are deemed necessary for the development of BP-specific diagnostic and treatment protocols.
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Affiliation(s)
- Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Vlahović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, 11000 Belgrade, Serbia
| | - Mladen Jovanović
- Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Jovićević
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dolika Vasović
- Clinic for Eye Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Safdar OY, Basunbul LI, Alhazmi LS, Almughamisi SA, Habib LA, Basaeed AJ, Kalaktawi NM, Alharithi ET, Aljaaly HA, Alzahrani WA. Necrotizing Fasciitis: A Side Effect of Rituximab Administration in Steroid-Dependent Nephrotic Syndrome. Int Med Case Rep J 2022; 15:587-592. [PMID: 36281444 PMCID: PMC9587699 DOI: 10.2147/imcrj.s347389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 09/17/2022] [Indexed: 11/08/2022] Open
Abstract
Steroid-dependent nephrotic syndrome (SDNS) is a common type of childhood nephrotic syndrome. Remission following steroid therapy is achieved in 80-90% of the patients, while the remainder show steroid-resistant nephrotic syndrome (SRNS). Rituximab is an anti-CD20 chimeric monoclonal antibody with proven therapeutic effects in several diseases and has been used with great success in the treatment of NS since its discovery. We report a case of a 4-year-old girl diagnosed with SDNS at the age of 3. As treatment with steroids, enalapril, and mycophenolate failed to produce complete remission, rituximab was initiated, and remission was successfully achieved after administration of the first dose. Due to this response, rituximab therapy was continued; however, a day after being admitted to the nephrology ward for the second dose, she started to develop a high fever, which reached up to 40°C. In addition, she also displayed symptoms of upper respiratory tract infection and an ulcerated wound on her left cheek. The patient became drowsy with reactive pupils, cold peripheries, and weak peripheral pulses. The capillary refill time was prolonged to 3-4 seconds and it was decided to withhold the second dose of rituximab. The patient was shifted to the PICU as a case of septic shock secondary to facial cellulitis and started on inotropes (epinephrine and norepinephrine), meropenem, vancomycin, and hydrocortisone 15 mg. Thereafter, surgical debridement of the wound was carried out. The patient remained in remission with regard to nephrotic syndrome and was discharged in a healthy condition. In conclusion, rituximab used in conjunction with steroids and other immunosuppressants may increase the risk of serious infections like necrotizing fasciitis (NF). Further studies are needed to explore the relationship between rituximab and NF.
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Affiliation(s)
- Osama Yousif Safdar
- Pediatric Nephrology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Lama Islem Basunbul
- Pediatric Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | | | - Laura Ahmed Habib
- Pediatric Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Nada M Kalaktawi
- Pediatric Nephrology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Hataan A Aljaaly
- Plastic Surgery Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Walaa A Alzahrani
- Pediatric Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia,Correspondence: Walaa A Alzahrani, Pediatric Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Tel +966 546239898, Email
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