Nekrotizan Fasiit: Nadir Bir Olgu

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

M.ş. Paksu A.g. Kalaycı E.g. Okur, F. Öztürk

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.

Keywords

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