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Nekrotizan Fasiit: Nadir Bir Olgu

Year 2006, Volume: 23 Issue: 3, 101 - 105, 30.12.2009

Abstract

Necrotizing Fasciitis: A Rare Case
Necrotizing fasciitis is a life threatening soft-tissue infection characterized by progressive necrosis of skin, subcutaneous tissues and fasciae. Morbidity and mortality rates are high despite early diagnosis and treatment. An eleven year-old male patient presented to our emergency service with swelling and pain on his left arm; both set on the day before. Physical examination revealed swelling, heat and pain related to passive movement; erythema was absent. During follow-up, area involved developed echymotic bullous lesions; which shortly spread to the lateral chest wall. Although appropriate antibiotherapy and supportive management, lesions progressed and the patient deceased due to septic shock on the s e c o n d day of his admission. The culture of the aspirate of the bullae revealed Streptococcus pyogenes.
Although it can occasionally be encountered on completely healthy individuals, necrotizing fasciitis is more likely occur along with predisposing factors such as trauma, surgical inte rve n tio n, systemic disorders, chicken pox, insect bites, immune compromising situations, and parenteral drug use.
Although there are no reports concerning increased risk of necrotizing fasciitis in the presence of cutis laxae, we report a case of fatal necrotising fasciitis in an individual who was diagnosed cutis laxae.


Nekrotizan fasiit (NF); deri, subkutan dokular ve fasyalann ilerleyici nekrozu ile karakterize, yaşamı tehdit eden bir yumuşak doku enfeksiyonudur. Erken tanı ve tedaviye rağmen mortalite ve morbiditesi yüksektir. On bir yaşında erkek hasta sol kolunda bir gün önce başlayan şişlik ve ağrı yakınmaları ile acil polikliniğimize başvurdu. Fizik muayenede sol kolda şişlik, ısı artışı ve pasif hareketlerle ağrı mevcuttu, kızarıklık yoktu. İzleminde etkilenen bölge üzerinde ekimotik-büllöz lezyonlar oluştu ve bu lezyonlar göğüs yan duvarına yayıldı. Uygun antibiyotik ve destek tedavisine rağmen lezyonlar hızla ilerledi ve yatışının ikinci gününde septik şok nedeniyle hasta kaybedildi. Aspire edilen bül sıvısında Streptococcus pyogenes üredi.Nekrotizan fasiit tamamen sağlıklı bireylerde de görülebilmesine karşın travma, cerrahi işlem, sistemik hastalıklar, su çiçeği, böcek ısırması, bağışıklık sistemini baskılayan durumlar, parenteral ilaç kullanımı gibi hazırlayıcı faktörlerin varlığında sıklığı artan bir hastalıktır. Hiperelastisite ile seyreden hastalıklarda nekrotizan fasiit için artmış risk bildirilmeme-sine rağmen kutis laksa tanısı olan bir çocuk hastada fatal seyirli nekrotizan fasiit olgusunu sunduk.

References

  • Kosloske AM, Cushing AH, Borden TA, et.al. Cellulitis and necrotizing fasciitis of the abdominal wall in p e d i a t r i c patients. J Pediatr Surg 1981; 16: 246–251.
  • Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotizing infections of soft tissues-a clinical profile. Eur J Surg 2002; 168: 366–371.
  • Patino JF, Castro D. Necrotizing lesions of soft tissues: a review. World J Surg 1991; 15: 235–239.
  • Wilson HD, Haltalin KC. Acute necrotizing fasciitis in childhood. Report of 11 cases. Am J Dis Child 1973; 125: 591–595.
  • Mordehai J, Kurzbart E, Cohen Z, Mares AJ. Necrotizing fasciitis and myonecrosis in early childhood: a report of three patients. Pediatr Surg Int 1997; 12: 538–540.
  • Di Falco G, Guccione C, D’Annibale A, et.al. Fornier’s gangrene following a peianal abscess. Dis Colon Rectum 1986; 29: 582–585.
  • Simonart T. Group A beta-haemolytic streptococcal necrotizing fasciitis: early diagnosis and clinical f e a t u r e s . Dermatology 2004; 208: 5–9.
  • Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am 2002; 16: 697–712.
  • Riefler J, Molavi A, Schwartz D, Dinubile M. Necrotizing fasciitis in adults due to group B streptococcus. Report of a case and review of the literature. Arch Intern Med 1988; 148: 727–729.
  • Duncan BW, Adzick NS, deLorimier AA, et.al. Necrotizing fasciitis in two children with acute l y m p h o b l a s t i c leukemia. J Pediatr Surg 1992; 27: 668–671.
  • Vijaykumar, Rao PS, Bhat N, Chattopadhyay A, Nagendhar MY. Necrotizing fasciitis with chickenpox. Indian J Pediatr 2003; 70: 961–963.
  • Clark P, Davidson D, Letts M, Lawton L, Jawadi A. Necrotizing fasciitis secondary to chickenpox infection in children. Can J Surg 2003; 46: 9–14.
  • Aslan A, Jerome CP, Borthne A. Necrotizing fasciitis: unreliable MRI findings in preoperative diagnosis. Eur J Radiol 2000; 36: 139–143.
  • American Academy of Pediatrics Committeee on Infectious Diseases. Severe invasive group A s t r e p o c o c c a l infections: a subject review. Pediatrics 1998; 101: 136–140.
  • Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery. 1990; 108: 847–850.
  • Wykosi MG, Santora TA, Shah RM, Friedman AC.Necrotizing fasciitis: CT characteristics. Radiology. 1997; 203: 859–863.
  • Jallali N. Necrotizing fasciitis: its aetiology, diagnosis and management. Nurs Times 2003; 99: 51–53.
  • Dahl PR, Perniciaro C, Holmkvist KA, O’Connor MI, Gibson LE. Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients. J Am Acad Dermatol 2002; 47: 489–492.
  • Murphy JJ, Granger R, Blair GK, Miller GG, Fraser GC, Magee JF. Necrotizing fasciitis in childhood. J Pediatr Surg 1995; 30: 1131–1134
  • Brown DR, Davis NL, Lepawsky M, Cunningham J, Kortbeek J. A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 1994; 167: 485–489.
  • Farrell LD, Karl SR, Davis PK, Bellinger MF, Ballantine TV. Postoperative necrotizing fasciitis in children. Pediatrics 1988; 82: 874–879.
  • Brooks I., Frazier EH. Clinical and microbiological features of necrositing fasciitis. J Clin Microbiol 1995; 33: 2382–2387.
  • Scott SD, Dawes RF, Tate JJ, Royle GT, Karran SJ. The practical management of Fournier’s gangrene. Ann R Coll Surg Engl. 1988; 70: 16–20.
  • Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes i n f e c t i o n. Pediatr Infect Dis J 1999; 18: 1096–1100.
  • Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996; 224: 672–683.
Year 2006, Volume: 23 Issue: 3, 101 - 105, 30.12.2009

Abstract

References

  • Kosloske AM, Cushing AH, Borden TA, et.al. Cellulitis and necrotizing fasciitis of the abdominal wall in p e d i a t r i c patients. J Pediatr Surg 1981; 16: 246–251.
  • Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotizing infections of soft tissues-a clinical profile. Eur J Surg 2002; 168: 366–371.
  • Patino JF, Castro D. Necrotizing lesions of soft tissues: a review. World J Surg 1991; 15: 235–239.
  • Wilson HD, Haltalin KC. Acute necrotizing fasciitis in childhood. Report of 11 cases. Am J Dis Child 1973; 125: 591–595.
  • Mordehai J, Kurzbart E, Cohen Z, Mares AJ. Necrotizing fasciitis and myonecrosis in early childhood: a report of three patients. Pediatr Surg Int 1997; 12: 538–540.
  • Di Falco G, Guccione C, D’Annibale A, et.al. Fornier’s gangrene following a peianal abscess. Dis Colon Rectum 1986; 29: 582–585.
  • Simonart T. Group A beta-haemolytic streptococcal necrotizing fasciitis: early diagnosis and clinical f e a t u r e s . Dermatology 2004; 208: 5–9.
  • Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am 2002; 16: 697–712.
  • Riefler J, Molavi A, Schwartz D, Dinubile M. Necrotizing fasciitis in adults due to group B streptococcus. Report of a case and review of the literature. Arch Intern Med 1988; 148: 727–729.
  • Duncan BW, Adzick NS, deLorimier AA, et.al. Necrotizing fasciitis in two children with acute l y m p h o b l a s t i c leukemia. J Pediatr Surg 1992; 27: 668–671.
  • Vijaykumar, Rao PS, Bhat N, Chattopadhyay A, Nagendhar MY. Necrotizing fasciitis with chickenpox. Indian J Pediatr 2003; 70: 961–963.
  • Clark P, Davidson D, Letts M, Lawton L, Jawadi A. Necrotizing fasciitis secondary to chickenpox infection in children. Can J Surg 2003; 46: 9–14.
  • Aslan A, Jerome CP, Borthne A. Necrotizing fasciitis: unreliable MRI findings in preoperative diagnosis. Eur J Radiol 2000; 36: 139–143.
  • American Academy of Pediatrics Committeee on Infectious Diseases. Severe invasive group A s t r e p o c o c c a l infections: a subject review. Pediatrics 1998; 101: 136–140.
  • Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery. 1990; 108: 847–850.
  • Wykosi MG, Santora TA, Shah RM, Friedman AC.Necrotizing fasciitis: CT characteristics. Radiology. 1997; 203: 859–863.
  • Jallali N. Necrotizing fasciitis: its aetiology, diagnosis and management. Nurs Times 2003; 99: 51–53.
  • Dahl PR, Perniciaro C, Holmkvist KA, O’Connor MI, Gibson LE. Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients. J Am Acad Dermatol 2002; 47: 489–492.
  • Murphy JJ, Granger R, Blair GK, Miller GG, Fraser GC, Magee JF. Necrotizing fasciitis in childhood. J Pediatr Surg 1995; 30: 1131–1134
  • Brown DR, Davis NL, Lepawsky M, Cunningham J, Kortbeek J. A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 1994; 167: 485–489.
  • Farrell LD, Karl SR, Davis PK, Bellinger MF, Ballantine TV. Postoperative necrotizing fasciitis in children. Pediatrics 1988; 82: 874–879.
  • Brooks I., Frazier EH. Clinical and microbiological features of necrositing fasciitis. J Clin Microbiol 1995; 33: 2382–2387.
  • Scott SD, Dawes RF, Tate JJ, Royle GT, Karran SJ. The practical management of Fournier’s gangrene. Ann R Coll Surg Engl. 1988; 70: 16–20.
  • Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes i n f e c t i o n. Pediatr Infect Dis J 1999; 18: 1096–1100.
  • Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996; 224: 672–683.
There are 25 citations in total.

Details

Primary Language English
Journal Section Basic Medical Sciences
Authors

M.ş. Paksu This is me

A.g. Kalaycı This is me

E.g. Okur, This is me

F. Öztürk This is me

Publication Date December 30, 2009
Submission Date October 23, 2009
Published in Issue Year 2006 Volume: 23 Issue: 3

Cite

APA Paksu, M., Kalaycı, A., Okur, E., Öztürk, F. (2009). Nekrotizan Fasiit: Nadir Bir Olgu. Journal of Experimental and Clinical Medicine, 23(3), 101-105. https://doi.org/10.5835/jecm.v23i3.42
AMA Paksu M, Kalaycı A, Okur, E, Öztürk F. Nekrotizan Fasiit: Nadir Bir Olgu. J. Exp. Clin. Med. December 2009;23(3):101-105. doi:10.5835/jecm.v23i3.42
Chicago Paksu, M.ş., A.g. Kalaycı, E.g. Okur, and F. Öztürk. “Nekrotizan Fasiit: Nadir Bir Olgu”. Journal of Experimental and Clinical Medicine 23, no. 3 (December 2009): 101-5. https://doi.org/10.5835/jecm.v23i3.42.
EndNote Paksu M, Kalaycı A, Okur, E, Öztürk F (December 1, 2009) Nekrotizan Fasiit: Nadir Bir Olgu. Journal of Experimental and Clinical Medicine 23 3 101–105.
IEEE M. Paksu, A. Kalaycı, E. Okur, and F. Öztürk, “Nekrotizan Fasiit: Nadir Bir Olgu”, J. Exp. Clin. Med., vol. 23, no. 3, pp. 101–105, 2009, doi: 10.5835/jecm.v23i3.42.
ISNAD Paksu, M.ş. et al. “Nekrotizan Fasiit: Nadir Bir Olgu”. Journal of Experimental and Clinical Medicine 23/3 (December 2009), 101-105. https://doi.org/10.5835/jecm.v23i3.42.
JAMA Paksu M, Kalaycı A, Okur, E, Öztürk F. Nekrotizan Fasiit: Nadir Bir Olgu. J. Exp. Clin. Med. 2009;23:101–105.
MLA Paksu, M.ş. et al. “Nekrotizan Fasiit: Nadir Bir Olgu”. Journal of Experimental and Clinical Medicine, vol. 23, no. 3, 2009, pp. 101-5, doi:10.5835/jecm.v23i3.42.
Vancouver Paksu M, Kalaycı A, Okur, E, Öztürk F. Nekrotizan Fasiit: Nadir Bir Olgu. J. Exp. Clin. Med. 2009;23(3):101-5.