good info on necrotizing fasciitis

[EMEDPA]

Subject: EMedHome Clinical Pearl
 

Necrotizing Fasciitis - Making The Diagnosis The First Time

Prompt diagnosis of necrotizing fasciitis and early intervention reduces mortality and amputation rates. Unfortunately, making the diagnosis early is a challenge. A recent review found that NF was misdiagnosed in the initial stage of disease in almost three-quarters of patients (1).

Patients with NF usually present with the triad of pain, swelling and erythema (1-3). It is often misdiagnosed as cellulitis or abscess. The most consistent feature of early NF is that the pain is out of proportion to the swelling or erythema (1,2). Four other features are diagnostic clues to differentiate NF from simple soft tissue infection (1,4):

• the tenderness extends beyond the apparent involved area owing to enzymes and toxins spreading along the fascia below the skin
• margins of involvement are indistinct
• lymphangitis is rarely seen in NF because the infection is in the deep fascia and not in the skin
• NF is rapidly progressive despite the use of antibiotics

References:
(1) Goh T, et al. Br J Surgery January 2014, Vol. 101, Issue 1, pages e119-e125.
(2) Hsiao C, et al. Am J Emerg Med 2008; 26: 170-175.
(3) Huang KF, et al. J Trauma 2011; 71: 467-473.
(4) Majeski J, Majeski E. South Med J 1997; 90: 1065-1068.

 

 

[Derbingle]

Great info. I have admitted two questionable lower leg cellulitis, that turned out to surical debridement, admitted due much of what you said but the Main reason I got ID on board amd admitted was bc of rapid progression. Like the pain out of proportion, erythematous assymetric progression within 12-24 hours amazing) and deep the tissue pain over area that appear non affected as you said. Were very interesting cases.

[RetNavyPAC]

I posted this Clinical Pearl this week for my group

 

Scary stuff.  I'm doing a med mal review right now for a PA being sued for missed nec fasc.