Necrotizing soft-tissue infection of the upper extremity following a toothpick injury: Case report and a literature review

Year 2024, Volume: 1 Issue: 2, 75 - 80, 14.06.2024

Enes Zogic , Haris Plojovic , Mirza Corovic , Dragan Veljovic , Dzenana Hamzic Plojovic , Dzenana Detanac , Demet Sengul , Ilker Sengul , Dzemail Detanac

Abstract

NSTIs (Necrotizing soft-tissue tissue infections) are severe surgical infections characterized by rapid spread over the superficial fascia and involve the subcutaneous tissue, fascia, and sometimes muscles. At the same time, the skin may appear intact at the beginning of the disease, which might lead to severe systemic complications that may end fatally for the patient. Early recognition and urgent surgical intervention with appropriate antibiotics and other supportive measures are the most important in treating these infections. The presence of comorbidities complicates treatment. Diabetes and heart diseases are the most common comorbidities in patients with NSTIs. Reminding clinicians about this infection is essential in order to recognize it and provide adequate and timely treatment quickly. To that end, we present a patient with NSTIs of the upper extremity after being pricked by a used toothpick.

Keywords

Soft-tissue, Necrotizing soft-tissue infections, LRINEC, Surgical exploration, Toothpick, Soft-tissue Pathology

References

• Detanac D, Mujdragic M, Detanac DA, et al. Necrotizing soft tissue infection: a single-center retrospective study of treatment and outcomes. Cureus. 2021;13(5):e15039. doi: 10.7759/cureus.15039
• Detanac DS, Mujdragić M, Detanac DA, Mulić M, Mujdragić H. Necrotising fascitis: a life-threatening infection: case reports and literature review. Srpski arhiv za celokupno lekarstvo. 2021;149(7-8):476-80. doi: 10.2298/SARH200420023D
• Arrestier R, Chaba A, Mabrouki A, et al. Necrotizing soft tissue infections in critically ill neutropenic patients: a French multicentre retrospective cohort study. Ann Intensive Care. 2023;13(1):34. doi:10.1186/s13613-023-01125-w
• Chang MC, Huang YL, Liu Y, Lo WH. Infectious complications associated with toothpick injuries of the hand. J Hand Surg Am. 2003;28(2):327-31. doi:10.1053/jhsu.2003.50039
• Li M, Zhu Z, Deng D, Sun C. An unusual cause of abdominal pain in an older woman. Rev EspEnferm Dig. doi:10.17235/reed.2023.9898/2023.Epub ahead of print.
• Cheng YC, Liu PY, Hu SY. Treating an intramuscular abscess following toothpick injury in a diabetic patient: a case report and literature review (CARE Complaint). Medicine (Baltimore). 2019;98(48):e18159. doi:10.1097/MD.0000000000018159
• Detanac D, Marovac S, Sengul I, et al. Severe frostbite on both hands and feet in a vignette case: from physics to clinics. Cureus. 14(9):e29085. doi: 10.7759/cureus.29085
• Sengul I, Sengul D. Deep soft tissue leiomyoma of the lower extremities: a case report. Acta Chir Belg. 2009;109(1):112-3. doi:10.1080/00015458.2009.11680386
• Zogic E, Alihodzic K, Tokovic D, Nicevic A. Necrotizing soft tissue infections: An unpredictible, life-threatening infections. Sanamed. 2023;18(2):91-2. doi: 10.5937/sanamed0-45959.
• Bodansky DMS, Begaj I, Evison F, Webber M, Woodman CB, Tucker ON. A 16-year longitudinal cohort study of incidence and bacteriology of necrotising fasciitis in England. World J Surg. 2020,44:2580-91. 10.1007/s00268-020-05559-2
• Stevens DL, Bryant AE, Goldstein EJ. Necrotizing Soft Tissue Infections. Infect Dis Clin North Am. 2021;35(1):135-55. doi:10.1016/j.idc.2020.10.004
• Salati SA. Necrotizing fasciitis a review. Pol Przegl Chir. 2022;95(2):1-8. doi:10.5604/01.3001.0015.7676
• Kim T, Park SY, Kwak YG, et al. Etiology, characteristics, and outcomes of community-onset necrotizing fasciitis in Korea: a multicenter study. PLoS One. 2019, 14:e0218668. doi:10.1371/journal.pone.0218668
• EckmannC, Lawson W, Nathwani D, et al. Antibiotic treatment patterns across Europe in patients with complicated skin and softtissue infections due to meticillin-resistant Staphylococcus aureus: a plea for implementation of early switch and early discharge criteria. Int J Antimicrob Agents. 2014; 44(1):56-64. doi:10.1016/j.ijantimicag.2014.04.007
• Saeed K, Esposito S, Gould I, et al. Hot topics in necrotising skin and soft tissue infections. Int J Antimicrob Agents. 2018; 52(1):1-10. doi: 10.1016/j.ijantimicag.2018.02.012
• Peetermans M, de Prost N, Eckmann C, Norrby-Teglund A, Skrede S, De Waele JJ. Necrotizing skin and soft-tissue infections in the intensive care unit. Clin Microbiol Infect. 2020;26(1):8-17. doi: 10.1016/j.cmi.2019.06.031
• Tarchouli M, Bounaim A, Essarghini M, et al.Analysis of prognostic factors affecting mortality in Fournier's gangrene: a study of 72 cases. Can Urol Assoc J. 2015, 9(11-12):E800-4. doi: 10.5489/cuaj.3192
• Dorazio J, Chiappelli AL, Shields RK, et al. Clindamycin plus Vancomycin versus Linezolid for treatment of necrotizing soft tissue infection. Open Forum Infect Dis. 2023;10(6):ofad258. doi:10.1093/ofid/ofad258
• Sartelli M. Leveraging the synergy between antimicrobial stewardship and infection prevention and control in fighting antimicrobial resistance. Sanamed. 2021;16(3):231-3. doi: 10.24125/sanamed.v16i3.524
• Hoesl V, K empa S , P rantl L , e t a l. T he L RINEC s core-an indicator for the course and prognosis of necrotizing fasciitis? J Clin Med. 2022;11(13):3583. doi: 10.3390/jcm11133583