Necrotizing fasciitis caused by Pseudomonas aeruginosa: a rare case report and recent concepts in diagnosis and management

Authors

  • Naresh Kumar Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
  • Akshay Lamba Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
  • Jyotirmay Das Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
  • Avik K. Neogi Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
  • Kunal Arora Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
  • Surinder Jaiswal Department of Orthopaedics, Pt. BDS PGIMS, Rohtak, Haryana, India
  • Mayank Jain Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
  • Sargam Chhabra Department of Ophthalomology, PGIMS, Rohtak, Haryana, India
  • Urvashi Sharma Department of Medicine, PGIMS, Rohtak, Haryana, India
  • Navdeep Malik Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203484

Keywords:

Necrotizing fasciitis, Pseudomonas aeruginosa, Aggressive soft tissue infection, Debridement

Abstract

Necrotizing fasciitis caused by Pseudomonas aeruginosa is an extremely rare and life threatening bacterial soft tissue infection. Here we report a case study of fully established necrotizing fasciitis associated with monomicrobial pseudomonas infection in a 34 years old male. The patient presented with painful, necrosed areas of skin and soft tissue over right gluteal region which rapidly progressed to right upper back. Aggressive supportive measures and early debridement lead to a full recovery with no functional deficits.

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Author Biographies

Naresh Kumar, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Akshay Lamba, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Jyotirmay Das, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Avik K. Neogi, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Kunal Arora, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Surinder Jaiswal, Department of Orthopaedics, Pt. BDS PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Mayank Jain, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

Sargam Chhabra, Department of Ophthalomology, PGIMS, Rohtak, Haryana, India

Resident Ophthalmologist

Urvashi Sharma, Department of Medicine, PGIMS, Rohtak, Haryana, India

Resident Physician

Navdeep Malik, Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Resident Orthopaedic Surgeon

References

Wilson B. Necrotizing fasciitis. Am Surg. 1952;18:416.

Meleney FL. Hemolytic streptococcus gangrene. Arch Surg. 1924;9:317-64.

Mccafferty ELJ, Lyons C. Suppurative fasciitis as the essential feature of hemolytic streptococcus gangrene with notes on fasciotomy and early wound closure as the treatment of choice. Surgery. 1948;24:438-42.

Giuliano A, Lewis JF, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg. 1977;134:52-7.

Morgan MS. Diagnosis and management of necrotizing fasciitis: a multipara-metric approach. J Hosp Infect. 2010;75:249-57.

Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36.

Kappers MH, Klooster VJM, Ouwenkijk RJ, Dees A. Community-acquired necrotizing fasciitis due to Pseudomonas aeruginosa. Intensive Care Med. 2006;32:1093-4.

Mantadakis E, Pontikoglou C, Papadaki HA, Aggelidakis G, Samonis G. Fatal Fournier’s gangrene in a young adult with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:862-4.

Akita S, Tanaka K, Hirano A. Lower extremity reconstruction after necrotizing fasciitis and necrotic skin lesion using a porcine derived skin substitute. J Plast Reconstr Anesthet Surg. 2006;59:759-63.

Tsung LWT, Cheng SN, Wang CC, Chu ML. Extensive necrotizing fasciitis caused by Pseudomonas aeruginosa in a child with acute myeloid leukaemia: case report and literature review. Eur J Pediatr. 2005;164:113-4.

Neo EN, Haritharan T, Thambidorai CR, Suresh V. Pseudomoas necrotizing fasciitis in an immunocompetent infant. Pediatr Infect Dis J. 2005;24:942-3.

Virgili A, Colombo E, Serino R, Pedretti S, Corazza M. Necrotizing fasciitis from Pseudomonas aeruginosa in infantile acute lymphoblastic leukaemia. Acta Derm Venereol. 2005;85:538-9.

Jaing TH, Huang CS, Chiu CH. Surgical implications of Pseudomonas aeruginosa necrotizing fasciitis in a child with acute lymphoblastic leukemia. J Pediatr Surg. 2001;36:948-50.

Tsekouras AA, Johnson A, Miller G, Orton HI. Pseudomonas aeruginosa necrotizing fasciitis: a case report. J Infec. 1998;37:188-90.

Pauzner D, Wolman I, Abramov L, Lidor A, David MP. Post cesarean-section necrotizing fasciitis: report of a case and review of literature. Gynecol Obstet Invest. 1994;37:59-62.

Maqbool M, Ahamad R, Qazi S. Necrotizing fasciitis in the head and neck region. Br J Plast Surg. 1992;45:481-3.

Duncan BW, Adzick NS, deLorimier AA. Necrotizing fasciitis in two children with acute lymphoblastic leukemia. J Pediatr Surg. 1992;27:668-71.

Veenstra RP, Manson WE, Werf VTS, Fijen JW, Tulleken JE, Zijlstra JG, et al. Fulminant necrotizing fasciitis and nonsteroidal anti-inflammatory drugs. Intensive Care Med. 2001;27:1831.

Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC, et al. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002;68:109-16.

Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Br J Surg. 2013;101:119-25.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004; 32:1535-41.

Brothers TE, Tagge DU, Stutley JRE, Conway WF, Schutte DH, Byrne TK. Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg. 1998;187:417-21.

Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. Am J Roentgenol. 1998;170:615-20.

Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85:1454-60.

Wong CH, Yam AK, Tan AB, Song C. Approach to debridement in necrotizing fasciitis. Am J Surg. 2008;196:19-24.

Reisman JS, Weinberg A, Ponte C, Kradin R. Monomicrobial Pseudomonas necrotizing fasciitis: a case of infection by two strains and a review of 37 cases in the literature. Scand J Infect Dis. 2012;44:216-21.

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Published

2020-08-26

How to Cite

Kumar, N., Lamba, A., Das, J., Neogi, A. K., Arora, K., Jaiswal, S., Jain, M., Chhabra, S., Sharma, U., & Malik, N. (2020). Necrotizing fasciitis caused by Pseudomonas aeruginosa: a rare case report and recent concepts in diagnosis and management. International Journal of Research in Orthopaedics, 6(5), 1100–1103. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203484