EXTENDED NECROTIZING FASCIITIS LOCALIZED AT THE LEVEL OF THE PERINEUM, BUTTOCK AND THE LOWER LIMB. CASE REPORT

Authors

  • C.D. BADIU “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
  • Mihaela MANDU “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
  • C.G. SMARANDACHE “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • C.G. POPESCU “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
  • D.N. PADURARU “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Claudia MEHEDINTU “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Liliana Florina ANDRONACHE “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • C.C. POPA “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • E. TURCU “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
  • V.T. GRIGOREAN “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania

Abstract

Necrotizing fasciitis, as the name suggests, is a rare, but potentially lethal infection, with a rapidly progressive character, of the deep or superficial fasciae of skeletal muscles. In the current paper, we aim at highlighting the importance of diabetes mellitus, particularly of undiagnosed diabetes, as well as the delayed presentation to the doctor, as important risk factors for the occurrence of necrotizing fasciitis and the rapid evolution of the infection. To this respect we exemplified through the case of a diabetic patient (unknown by the time of admission) who developed an extremely severe form of necrotizing fasciitis (actually, a necrotizing fasciomyositis), extended to several areas of the body (perineum, buttock, lower limb).

Author Biographies

  • C.D. BADIU, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania

    “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
    Faculty of Medicine

  • Mihaela MANDU, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania

    Medical Recovery Clinic

  • C.G. SMARANDACHE, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Faculty of Medicine
    University Emergency Hospital, Bucharest, Romania
    Department of General Surgery

  • C.G. POPESCU, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania

    Department of General Surgery,
    “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
     Faculty of Medicine

  • D.N. PADURARU, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Faculty of Medicine
    University Emergency Hospital, Bucharest, Romania
    Department of General Surgery

  • Claudia MEHEDINTU, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Faculty of Medicine

  • Liliana Florina ANDRONACHE, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Faculty of Medicine

  • C.C. POPA, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Faculty of Medicine
    University Emergency Hospital, Bucharest, Romania
    Department of General Surgery

  • E. TURCU, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania

    Department of Plastic and Reconstructive Surgery

  • V.T. GRIGOREAN, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania

    Department of General Surgery,
    “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
    Faculty of Medicine

References

1. Puvanendran R, Huey JCM, Pasupathy S. Necrotizing fasciitis. Can Fam Physician 2009; 55(10): 981-987.
2. Young MH, Engleberg NC, Mulla ZD, Aronoff DM. Therapies for necrotizing fasciitis. Expert Opin Biol Ther 2006; 6(2): 155-165.
3. Adewale AO, Olamide OT, Yussuf SA, Stephen IO. Cervicofacial Necrotizing Fasciitis in Patients with No Underlying Medical Conditions: A Review of Four Cases Seen in Twelve Months at a Nige-rian Tertiary Hospital. Iran J Med Sci 2018; 43(6): 653-658.
4. Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, et al. Fournier's Gangrene: Literature Review and Clinical Cases. Urol Int 2018; 101(1): 91-97.
5. Joshi N, Caputo MG, Weitekamp MR, Karchmer AW. Infections in Patients with Diabetes Mellitus. December 16, 1999 N Engl J Med 1999; 341:1906-1912.
6. Ardeleanu V, Toma A, Pafili K, et al. Current Pharmacological Treatment of Painful Diabetic Neu-ropathy: A Narrative Review‎. Medicina-Lithuania 2020; 56(1) Article Number: 25.
7. Hainarosie R, Zainea V, Rusescu A, et al. Management of infectious complications in diabetes mellitus mellitus patients‎; Romanian Journal of Military Medicine 2019; 122(1): 46-51.
8. Diaconu C, Paraschiv B, Stanescu AMA, et al. Arterial Hypertension, a Frequent Comorbidity in Diabetes: the Perioperative Management‎; Conference: 35th Balkan Medical Week on Healthy Ageing - An EndLess Challenge, 2018. Proceedings of the 35th Balkan Medical Week 2018; 15-20.
9. Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score for the assessment of early necrotizing fasciitis: a systematic review of the literature. Ann R Coll Surg Engl 2017; 99(5): 341-346.
10. Wong CH, Khin LW, Heng KS, et al. The LRINEC (Laboratory Risk Indicator For Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32(7): 1535-1541.
11. Hahn HM, Jeong KS, Park DH, Park MC, Lee IJ. Analysis of prognostic factors affecting poor out-comes in 41 cases of Fournier gangrene. Ann Surg Treat Res 2018; 95(6): 324-332.
12. Badiu CD, Mitu CA, Mandu M, Grigorean VT, et al. Necrotizing fasciomyositis localized in the lower limb - a multidisciplinary approach. Chirurgia 2019; 114 (Suppl. 2): S146.

Additional Files

Published

2020-06-30