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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 = [[vasculitis]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = sloughing, bulae, erythema | |||
| Grossing = | |||
| Site = [[skin]] / subcutaneous tissue | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-trauma | |||
| 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. | ||
It should '''''not''' to be confused with [[nodular fasciitis]]''. | It should '''''not''' to be confused with [[nodular fasciitis]]''. | ||
In the perineum/genital region it is known as ''Fournier gangrene''.<ref name=pmid23771967>{{Cite journal | last1 = Haemers | first1 = K. | last2 = Peters | first2 = R. | last3 = Braak | first3 = S. | last4 = Wesseling | first4 = F. | title = Necrotising fasciitis of the thigh. | journal = BMJ Case Rep | volume = 2013 | issue = | pages = | month = | year = 2013 | doi = 10.1136/bcr-2013-009331 | PMID = 23771967 }}</ref> | |||
==General== | ==General== | ||
* | Clinical: | ||
* | *Pain - classically out-of-keep with appearance. | ||
*Features of sepsis - late. | |||
*Often nonspecific.<ref name=pmid22491537/> | |||
Clinical DDx: | |||
*Abscess. | |||
*[[Cellulitis]]. | |||
Epidemiology: | |||
*Classically associated with ''Group A streptococcus''. | *Classically associated with ''Group A streptococcus''. | ||
*High mortality.<ref name=pmid22491537/> | |||
*Usually adults, sometimes children. | |||
Treatment: | Treatment: | ||
*Operative debridement. | *Operative debridement - emergency.<ref name=pmid22491537>{{Cite journal | last1 = Lancerotto | first1 = L. | last2 = Tocco | first2 = I. | last3 = Salmaso | first3 = R. | last4 = Vindigni | first4 = V. | last5 = Bassetto | first5 = F. | title = Necrotizing fasciitis: classification, diagnosis, and management. | journal = J Trauma Acute Care Surg | volume = 72 | issue = 3 | pages = 560-6 | month = Mar | year = 2012 | doi = 10.1097/TA.0b013e318232a6b3 | PMID = 22491537 }}</ref> | ||
*Broad spectrum antibiotics. | |||
Note: | |||
*May be diagnosed at [[frozen section]].<ref name=pmid9386043>{{Cite journal | last1 = Majeski | first1 = J. | last2 = Majeski | first2 = E. | title = Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. | journal = South Med J | volume = 90 | issue = 11 | pages = 1065-8 | month = Nov | year = 1997 | doi = | PMID = 9386043 }}</ref> | |||
==Gross== | |||
Features:<ref name=pmid22151905>{{Cite journal | last1 = Schuster | first1 = L. | last2 = Nuñez | first2 = DE. | title = Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence. | journal = Worldviews Evid Based Nurs | volume = 9 | issue = 2 | pages = 88-99 | month = Apr | year = 2012 | doi = 10.1111/j.1741-6787.2011.00235.x | PMID = 22151905 }}</ref> | |||
*Subcutaneous emphysema. | |||
*Edema. | |||
*Erythema. | |||
*Bulae. | |||
*Skin sloughing. | |||
===Image=== | |||
<gallery> | |||
Image:Necrotizing_fasciitis_left_leg.JPEG | Necrotizing fasciitis. (WC) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
| Line 15: | Line 75: | ||
*Necrosis of fascia - '''key feature'''.<ref name=pmid15735411>{{Cite journal | last1 = Wong | first1 = CH. | last2 = Wang | first2 = YS. | title = The diagnosis of necrotizing fasciitis. | journal = Curr Opin Infect Dis | volume = 18 | issue = 2 | pages = 101-6 | month = Apr | year = 2005 | doi = | PMID = 15735411 | URL = http://www.sepeap.org/archivos/pdf/9859.pdf }}</ref> | *Necrosis of fascia - '''key feature'''.<ref name=pmid15735411>{{Cite journal | last1 = Wong | first1 = CH. | last2 = Wang | first2 = YS. | title = The diagnosis of necrotizing fasciitis. | journal = Curr Opin Infect Dis | volume = 18 | issue = 2 | pages = 101-6 | month = Apr | year = 2005 | doi = | PMID = 15735411 | URL = http://www.sepeap.org/archivos/pdf/9859.pdf }}</ref> | ||
**[[PMN]]s and necrotic debris (amorphous grey or pink material). | **[[PMN]]s and necrotic debris (amorphous grey or pink material). | ||
*+/-Vascular thrombosis.<ref>{{Cite journal | last1 = Malghem | first1 = J. | last2 = Lecouvet | first2 = FE. | last3 = Omoumi | first3 = P. | last4 = Maldague | first4 = BE. | last5 = Vande Berg | first5 = BC. | title = Necrotizing fasciitis: contribution and limitations of diagnostic imaging. | journal = Joint Bone Spine | volume = 80 | issue = 2 | pages = 146-54 | month = Mar | year = 2013 | doi = 10.1016/j.jbspin.2012.08.009 | PMID = 23043899 }}</ref> | |||
Note: | Note: | ||
| Line 21: | Line 82: | ||
DDx: | DDx: | ||
*[[Cellulitis]]. | *[[Cellulitis]]. | ||
*[[Vasculitis]]. | |||
*[[Erythema nodosum]].{{fact}} | |||
===Images=== | ===Images=== | ||
| Line 27: | Line 90: | ||
Image:Necrotizing_fasciitis_-_high_mag.jpg | Necrotizing fasciitis - high mag. (WC) | Image:Necrotizing_fasciitis_-_high_mag.jpg | Necrotizing fasciitis - high mag. (WC) | ||
</gallery> | </gallery> | ||
==Sign out== | |||
<pre> | |||
Perianal Skin and Subcutaneous Tissue, Excision: | |||
- Consistent with clinical impression of necrotizing fasciitis. | |||
</pre> | |||
===Alternate=== | |||
<pre> | |||
Submitted as "Tissue from Left Elbow", Excision: | |||
- Skin and subcutaneous tissue with marked inflammation (see microscopic), | |||
consistent with clinical impression of necrotizing fasciitis. | |||
Comment: | |||
The positive tissue cultures are noted. | |||
</pre> | |||
====Micro==== | |||
Necrotic fascial tissue with inflamed adipose tissue and micro-abscess formation at dermis/subcutis interface. The overlying skin is moderately inflamed and edematous appearing. | |||
==See also== | ==See also== | ||