A Case Report of Subacute Necrotizing Fasciitis - A Rare Presentation

Abstract

Necrotizing fasciitis soft tissue infections (NSTIs) is an aggressive soft tissue infection. Diagnosis is challenging as the disease progresses below the surface of skin and the cutaneous manifestation belie the severity of disease. The emergence of subacute form NSTIs in the literature have raised concern on atypical presentation which make the diagnosis more difficult. Delayed diagnosis due to the atypical presentation will delay the appropriate treatment. A 71-year-old diabetic male presented with right thigh pain for 7days duration. It was associated with fever, lethargic and loss of appetite. Examination revealed tenderness and crepitus from the right buttock down to right suprapatellar region. There was no other classical skin manifestation of NSTIs. Investigation revealed subcutaneous emphysema over right thigh and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 8. Intraoperative finding confirmed the diagnosis of NSTIs. In contrast to classical NSTIs, the subacute form has a relatively slow clinical course which may endure for days or weeks. Necrotizing fasciitis is a life-threatening infection. Early diagnosis and surgical debridement is mandatory regardless of subacute or classical necrotizing fasciitis. Further studies into this enigmatic entity should be done for better understanding of subacute form of necrotizing fasciitis.

Keywords: Subacute, Diagnostic Criteria, Klebsiella P., Necrotizing Fasciitis