Necrotizing Fasciitis of the Soft Tissues of the Right Foot without Microbiology and Imaging: A Case Followed at the General Reference Hospital of Boma in the Democratic Republic of Congo
Necrotizing fasciitis is a life-threatening medical and surgical emergency. It is a bacterial complication caused by Streptococcus pyogenes or a mixture of aerobic and anaerobic bacteria, leading to necrosis of the subcutaneous tissue, which can spread along the fascia and adipose tissue at a rate of 2 to 3 cm/hour. In this paper, we report the case of a 54-year-old patient with no risk factors who presented with a vesicle at the base of the fourth toe of his right foot, which developed into a blister and phlyctenule containing purulent fluid, accompanied by fever, low blood pressure, pain, local heat, and edema in the right foot. The patient took systemic antibiotics and applied topical antibiotics and antiseptics. No bacteriological tests or imaging studies were performed. Necrotizing fasciitis is a soft tissue infection leading to necrosis of the fascia, the early diagnosis of which remains difficult and is based on a combination of clinical and paraclinical findings.
References
[1]
Ghezala, H.B. and Feriani, N. (2016) La fasciite nécrosante post opératoire: Une complication rare et mortelle. Pan African Medical Journal, 23, Article 123. https://doi.org/10.11604/pamj.2016.23.123.8734
[2]
Barant, S., Radbata, D., Oberweis, D., Jacobs, D., Marecaux, G., Zielonka, E. and Maréchal, M. (2016) Fasciite nécrosante de la paroi abdominale post-césarienne. Revue Médicale de Bruxelles, 37, 178-182.
[3]
Stevens, D.L., Bryant, A.E. and Goldstein, E.J.C. (2021) Necrotizing Soft Tissue Infections. Infectious Disease Clinics of North America, 35, 135-155. https://doi.org/10.1016/j.idc.2020.10.004
[4]
Ploy, M.-C. and Denis, F. (2011) Analyse cytobactériologique des pus. In: Bactériologie Médicale, Elsevier, 199-204. https://doi.org/10.1016/b978-2-294-09668-6.00020-2
[5]
Bluman, E.M., Mechrefe, A.P. and Fadale, P.D. (2005) Idiopathic Staphylococcus Aureus Necrotizing Fasciitis of the Upper Extremity. Journal of Shoulder and Elbow Surgery, 14, 227-230. https://doi.org/10.1016/j.jse.2004.06.003
[6]
Leong, H.N., Kurup, A., Tan, M.Y., Kwa, A.L.H., Liau, K.H. and Wilcox, M. (2018) Management of Complicated Skin and Soft Tissue Infections with a Special Focus on the Role of Newer Antibiotics. Infection and Drug Resistance, 11, 1959-1974. https://doi.org/10.2147/idr.s172366
[7]
Putri, A.I.W. and Novida, H. (2022) Necrotizing Fasciitis in Indonesian Adult with Diabetes Mellitus. International Journal of Surgery Case Reports, 92, Article 106890. https://doi.org/10.1016/j.ijscr.2022.106890
[8]
Amano, M., Namiki, T., Yoshioka, Y., Arima, Y., Kato, K., Nojima, K., et al. (2017) Necrotizing Fasciitis of the Lower Leg Caused by Escherichia coli, and an Association with Pyogenic Spondylitis. Clinical and Experimental Dermatology, 42, 918-920. https://doi.org/10.1111/ced.13209
[9]
Smeets, L., Bous, A., Lecoq, J.P., Damas, P. and Heymans, O. (2006) Fasciites nécrosantes: Stratégie diagnostique et thérapeutique. Revue Médicale de Liège, 61, 240-244.
[10]
Wong, C., Khin, L., Heng, K., Tan, K. and Low, C. (2004) The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) Score: A Tool for Distinguishing Necrotizing Fasciitis from Other Soft Tissue Infections. Critical Care Medicine, 32, 1535-1541. https://doi.org/10.1097/01.ccm.0000129486.35458.7d
[11]
Ramampisendrahova, J.B., Razafimahatratra, R. and Solofomalala, G.D. (2020) Fasciite nécrosante monomicrobienne de la jambe due à l’Acinetobacter baumannii multirésistante chez un adulte sain: Rapport d´un cas. Pan African Medical Journal, 36, Article 344. https://doi.org/10.11604/pamj.2020.36.344.24614
[12]
Umeda, M., Minamikawa, T., Komatsubara, H., Shibuya, Y., Yokoo, S. and Komori, T. (2003) Necrotizing Fasciitis Caused by Dental Infection: A Retrospective Analysis of 9 Cases and a Review of the Literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 95, 283-290. https://doi.org/10.1067/moe.2003.85
[13]
Yamaoka, M., Furusawa, K., Uematsu, T. and Yasuda, K. (1994) Early Evaluation of Necrotizing Fasciitis with Use of Ct. Journal of Cranio-Maxillofacial Surgery, 22, 268-271. https://doi.org/10.1016/s1010-5182(05)80074-5
[14]
Ali, S.Z., Srinivasan, S. and Peh, W.C.G. (2014) MRI in Necrotizing Fasciitis of the Extremities. The British Journal of Radiology, 87, Article 20130560. https://doi.org/10.1259/bjr.20130560
[15]
Frank, J., Barker, J.H. and Marzi, I. (2008) Necrotizing Fasciitis of the Extremities. European Journal of Trauma and Emergency Surgery, 34, 229-236. https://doi.org/10.1007/s00068-008-8074-0
[16]
Kumar, T., Kaushik, R., Singh, S., Sharma, R. and Attri, A. (2020) Determinants of Mortality in Necrotizing Soft Tissue Infections. Hellenic Journal of Surgery, 92, 159-164. https://doi.org/10.1007/s13126-020-0568-1
Taviloglu, K. and Yanar, H. (2007) Necrotizing Fasciitis: Strategies for Diagnosis and Management. World Journal of Emergency Surgery, 2, Article 19. https://doi.org/10.1186/1749-7922-2-19
