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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: | Clinical: | ||
*Pain - | *Pain - classically out-of-keep with appearance. | ||
*Features of sepsis - late. | *Features of sepsis - late. | ||
*Often nonspecific.<ref name=pmid22491537/> | *Often nonspecific.<ref name=pmid22491537/> | ||
| Line 11: | Line 44: | ||
Clinical DDx: | Clinical DDx: | ||
*Abscess. | *Abscess. | ||
*Cellulitis. | *[[Cellulitis]]. | ||
Epidemiology: | Epidemiology: | ||
| Line 37: | Line 70: | ||
Image:Necrotizing_fasciitis_left_leg.JPEG | Necrotizing fasciitis. (WC) | Image:Necrotizing_fasciitis_left_leg.JPEG | Necrotizing fasciitis. (WC) | ||
</gallery> | </gallery> | ||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
| Line 48: | Line 82: | ||
DDx: | DDx: | ||
*[[Cellulitis]]. | *[[Cellulitis]]. | ||
*[[Vasculitis]]. | |||
*[[Erythema nodosum]].{{fact}} | |||
===Images=== | ===Images=== | ||
| Line 54: | 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== | ||