Severe necrotizing fasciitis with fateful outcome

Abstract text (incl. references and figure legends)

Necrotizing fasciitis (NF) is rare.Incidence is 0,3/100000 cases.Despite increased awareness and treatment advances, mortality is high(30%).(1)(2)

The rapid progression of this disease and the subtlety of early signs and symptoms may delay diagnosis and surgery.Risk factors as diabetes,obesity or malignancy increase the morbimortality.(3)

CLINICAL CASE:58 years-old woman had cervical carcinoma in 2018 treated with chemotherapy, radiotherapy and brachytherapy. As complications: radiation enteritis and cystitis with colovesical fistula that needed derivative ileostomy. In 2015,posterior pelvic exanteration with coloanal anastomosis, vaginal reconstruction and ileostomy closure was performed.In 2020 she noticed presense of pus in her vagina. CT scan showed: anastomosis leak, rectovaginal fistula and posterior sinus. Now, she was admitted in ER after 3 weeks of malaise, right leg edema and functional limitation. Physical exam manifested hemodynamic compromised and right limb erythema. Blood test showed leukocytosis (16000), PCR 39mg/dl, Procalcitonin 22mg/dl. CT scan revealed rectovaginal fistula with a 8,2x4 cm collection; obturador, iliacus and thigh muscles fasciitis and coxofemoral joint osteomyelitis. An urgent intervention was performed evidencing the CT findings. We performed a surgical debridament of necrotic soft tissue, right coxofemoral joint resection, also we placed some drainages. Patient was admitted to intensive care due to severe sepsis.Subsequently, several surgeries were performed with no clinical improvement.Due to this critical situation, without medical or surgical sort out, a multidisciplinary committee decided to practice limitation of therapeutic effort, subsequently patient passed away.

Comments: NF requires an aggressive treatment.Surgical delay increases morbimortality.

Cancer,immunosuppression, obesity are risk factors.

Hyperbaric treatment was described for NF. Actually there is not strong evidence for this recommendation.(2)(4)

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