Missed acute appendicitis presenting as necrotising fasciitis of the thigh

Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a...

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Bibliographic Details
Published in:BMJ case reports 2014-05, Vol.2014, p.bcr2014204247
Main Authors: Taif, Sawsan, Alrawi, Asif
Format: Article
Language:English
Subjects:
Abdomen
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotics
Appendectomy
Appendicitis
Appendicitis - complications
Appendicitis - diagnosis
Appendicitis - therapy
Arthritis
Cardiac arrhythmia
Collections
Debridement
Delayed Diagnosis
Escherichia coli Infections - complications
Escherichia coli Infections - diagnosis
Escherichia coli Infections - therapy
Fasciitis, Necrotizing - complications
Fasciitis, Necrotizing - diagnosis
Fasciitis, Necrotizing - therapy
Fatal Outcome
Female
Gangrene
Humans
Laboratories
Magnetic Resonance Imaging
Medical imaging
Medical prognosis
Middle East
Mortality
Other Asian
Pain
Patients
Proteus Infections - complications
Proteus Infections - diagnosis
Proteus Infections - therapy
Skin
Staphylococcal Infections - complications
Staphylococcal Infections - diagnosis
Staphylococcal Infections - therapy
Staphylococcus infections
Streptococcal Infections - complications
Streptococcal Infections - diagnosis
Streptococcal Infections - therapy
Surgery
Thigh - surgery
Thrombosis
Unusual Presentation of More Common Disease/Injury
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Summary:Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a 26-year-old woman who presented with severe thigh pain and swelling associated with irritability of a few hours’ duration following 2 days history of right abdominal pain. Urgent MRI and CT scan showed features of necrotising fasciitis in the thigh spreading from an inflamed appendix. Emergency surgery was performed which revealed perforated appendix with disseminated infection in the intraperitoneal and retroperitoneal spaces as well as the right thigh. The patient rapidly deteriorated with evidence of sepsis, shock and renal impairment. In spite of surgery and all supportive measures, she succumbed shortly postoperatively. Blood culture revealed Staphylococcus aureus and Streptococci, while tissue culture showed growth of Escherichia coli and proteus.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-204247