Necrotizing Soft Tissue Infection Complicating Levamisole-Induced Vasculitis

The patient is a 52-year-old female with systemic lupus erythematosus, type II diabetes mellitus, chronic obstructive pulmonary disease, and hypothyroidism, who presented to a local emergency department with several days of subjective fever, nausea and vomiting, nasal congestion, ear pain, purpuric...

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Bibliographic Details
Published in:The American surgeon 2019-03, Vol.85 (3), p.145-147
Main Authors: Whitaker, Litton, Priest, Olivia, Pestana, Ivo A.
Format: Article
Language:English
Subjects:
Acidosis
Antirheumatic Agents - adverse effects
Autoimmune diseases
Biopsy
Chronic conditions
Chronic obstructive pulmonary disease
Cocaine
Diabetes mellitus
Emergency medical services
Extremities
Female
Fever
Humans
Hyperglycemia
Hyponatremia
Hypothyroidism
Infections
Lactic acidosis
Leg
Levamisole
Levamisole - adverse effects
Lung diseases
Lupus
Middle Aged
Muscles
Nausea
Necrosis
Necrotizing fasciitis
Neutropenia
Obstructive lung disease
Pain
Plastic surgery
Skin & tissue grafts
Skin Transplantation
Soft Tissue Infections - chemically induced
Soft Tissue Infections - microbiology
Soft Tissue Infections - surgery
Soft tissues
Systemic lupus erythematosus
Thrombocytopenia
Tissues
Urine
Vasculitis
Vasculitis - chemically induced
Vasculitis - microbiology
Vasculitis - surgery
Vomiting
Wound healing
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Summary:The patient is a 52-year-old female with systemic lupus erythematosus, type II diabetes mellitus, chronic obstructive pulmonary disease, and hypothyroidism, who presented to a local emergency department with several days of subjective fever, nausea and vomiting, nasal congestion, ear pain, purpuric rash of face and extremities, and joint pain. Blood work revealed thrombocytopenia, hyponatremia, hyperglycemia, and lactic acidosis. Because of her worsening clinical status, the patient was transferred to the intensive care unit at our institution with the working diagnosis of StevenJohnson syndrome. Intraoperative findings were consistent with necrotizing soft tissue infection, and full-thickness excision of involved soft tissues of the right lower extremity was completed to the level of viable muscle.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481908500311