Difference between revisions of "Necrotizing fasciitis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Necrotizing_fasciitis_-_high_mag.jpg | |||
| Width = | |||
| Caption = Necrotizing fasciitis. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = necrotic fascia - amorphous grey or pink material and [[neutrophil]]s | |||
| Subtypes = | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = sloughing, bulae, erythema | |||
| Grossing = | |||
| Site = [[skin]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = subcutaneous emphysema, edema, skin sloughing, bulae, erythema, signs of sepsis | |||
| Symptoms = pain | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = cellulitis, abscess | |||
| Tx = surgical debridement, antibiotics | |||
}} | |||
'''Necrotizing fasciitis''', also known as '''flesh-eating disease''', is an uncommon [[non-malignant skin disease]] with a high mortality. | '''Necrotizing fasciitis''', also known as '''flesh-eating disease''', is an uncommon [[non-malignant skin disease]] with a high mortality. | ||
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Image:Necrotizing_fasciitis_left_leg.JPEG | Necrotizing fasciitis. (WC) | Image:Necrotizing_fasciitis_left_leg.JPEG | Necrotizing fasciitis. (WC) | ||
</gallery> | </gallery> | ||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
Revision as of 04:04, 30 December 2013
| Necrotizing fasciitis | |
|---|---|
| Diagnosis in short | |
 Necrotizing fasciitis. H&E stain. | |
|
| |
| LM | necrotic fascia - amorphous grey or pink material and neutrophils |
| Gross | sloughing, bulae, erythema |
| Site | skin |
|
| |
| Signs | subcutaneous emphysema, edema, skin sloughing, bulae, erythema, signs of sepsis |
| Symptoms | pain |
| Prevalence | uncommon |
| Prognosis | poor |
| Clin. DDx | cellulitis, abscess |
| Treatment | surgical debridement, antibiotics |
Necrotizing fasciitis, also known as flesh-eating disease, is an uncommon non-malignant skin disease with a high mortality.
It should not to be confused with nodular fasciitis.
General
Clinical:
- Pain - classic out-of-keep with appearance.
- Features of sepsis - late.
- Often nonspecific.[1]
Clinical DDx:
- Abscess.
- Cellulitis.
Epidemiology:
- Classically associated with Group A streptococcus.
- High mortality.[1]
- Usually adults, sometimes children.
Treatment:
- Operative debridement - emergency.[1]
- Broad spectrum antibiotics.
Note:
- May be diagnosed at frozen section.[2]
Gross
Features:[3]
- Subcutaneous emphysema.
- Edema.
- Erythema.
- Bulae.
- Skin sloughing.
Image
Necrotizing fasciitis. (WC)
Microscopic
Features:
- Necrosis of fascia - key feature.[4]
- PMNs and necrotic debris (amorphous grey or pink material).
- +/-Vascular thrombosis.[5]
Note:
- Fat lobules between septae may be normal.
DDx:
Images
Necrotizing fasciitis - intermed. mag. (WC)
Necrotizing fasciitis - high mag. (WC)
See also
References
- ↑ 1.0 1.1 1.2 Lancerotto, L.; Tocco, I.; Salmaso, R.; Vindigni, V.; Bassetto, F. (Mar 2012). "Necrotizing fasciitis: classification, diagnosis, and management.". J Trauma Acute Care Surg 72 (3): 560-6. doi:10.1097/TA.0b013e318232a6b3. PMID 22491537.
- ↑ Majeski, J.; Majeski, E. (Nov 1997). "Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment.". South Med J 90 (11): 1065-8. PMID 9386043.
- ↑ Schuster, L.; Nuñez, DE. (Apr 2012). "Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence.". Worldviews Evid Based Nurs 9 (2): 88-99. doi:10.1111/j.1741-6787.2011.00235.x. PMID 22151905.
- ↑ Wong, CH.; Wang, YS. (Apr 2005). "The diagnosis of necrotizing fasciitis.". Curr Opin Infect Dis 18 (2): 101-6. PMID 15735411.
- ↑ Malghem, J.; Lecouvet, FE.; Omoumi, P.; Maldague, BE.; Vande Berg, BC. (Mar 2013). "Necrotizing fasciitis: contribution and limitations of diagnostic imaging.". Joint Bone Spine 80 (2): 146-54. doi:10.1016/j.jbspin.2012.08.009. PMID 23043899.