■坏死性筋膜炎(NF)是一种危及生命的疾病,皮肤和下面的软组织的快速进行性感染。细菌病原体引起毒性休克反应,减少血管流动,导致血栓形成,脓毒症,和组织坏死。治疗包括立即IV抗生素和经常手术干预。我们介绍了一例急性NF,误诊为蜂窝织炎。
方法:一名17岁男性从农村医院转到急诊科,进一步治疗右下肢蜂窝织炎和疑似败血症。在检查中,他的右小腿有一个溃疡病变。在4小时内,患者接受了筋膜切开术和清创术。病人住院10天,接受了3周疗程的头孢唑林,并接受了网状分裂厚度的皮肤移植。在他住院结束时,他表现出显著的临床改善。
■NF的误诊几乎总是导致预后较差。坏死性筋膜炎的实验室风险指标(LRINEC)评分用于区分NF与其他软组织感染。然而,其他诊断线索,如表现或疼痛与体检结果不成比例,可能是NF诊断的更相关的临床指标.此外,尽管NF的影像学发现可能是相关的,为了成像的目的,手术筋膜检查不得延迟。同样重要的是要注意蜂窝织炎和NF确实共享疾病谱。
结论:危及生命的NF感染似乎是蜂窝织炎的良性表现,因此,早期发现至关重要。
UNASSIGNED: Necrotizing Fasciitis (NF) is a life-threatening, rapidly progressive infection of the skin and underlying soft tissues. Bacterial pathogens induce a toxic-shock reaction that reduces vascular flow, causing thrombosis, sepsis, and tissue necrosis. Treatment consists of immediate IV antibiotics and oftentimes surgical intervention. We present a
case of acute NF that was misdiagnosed as
cellulitis.
METHODS: A 17-year-old male was transferred to an emergency department from a rural hospital for further management of right lower extremity
cellulitis and suspected sepsis. On examination, there was an ulcerated lesion on his right lower leg. Within 4 h, the patient underwent fasciotomy and debridement. The patient was hospitalized for 10 days, received a 3-week-course of Cefazolin, and underwent a meshed split-thickness skin graft. By the end of his hospital stay, he showed significant clinical improvement.
UNASSIGNED: Misdiagnosis of NF will almost always lead to a poorer prognosis. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to differentiate NF from other soft tissue infections. Yet, other diagnostic clues such as presentation or pain out of proportion to physical findings may be more relevant clinical indicators for a NF diagnosis. Moreover, though imaging findings of NF may be relevant, surgical fascial examination must not be delayed for the purpose of imaging. It is also important to note that
cellulitis and NF do share a disease spectrum.
CONCLUSIONS: A life-threatening NF infection may seem to be a benign-appearing
case of
cellulitis, and thus early detection is vital.