Necrotizing fasciitis after scalpel injury sustained during postmortem examination

A 44-year-old pathologist presented to the emergency department after sustaining a scalpel injury during a postmortem examination 16 hours previously. He had stabbed the dorsum of his left thumb overlying the interphalangeal joint and immediately irrigated the wound with water. At the time of presen...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2017-05, Vol.189 (20), p.E721-E723
Main Authors: Brichacek, Michal, Strazar, Robert, Murray, Kenneth A, Islur, Avinash
Format: Article
Language:English
Subjects:
Adult
Autopsy
Care and treatment
Case studies
Complications and side effects
Coroners and Medical Examiners
Development and progression
Fasciitis, Necrotizing - etiology
Fasciitis, Necrotizing - pathology
Fasciitis, Necrotizing - therapy
Fever
Fingers & toes
Humans
Infections
Infectious diseases
Injuries
Magnetic resonance imaging
Male
Necrotizing fasciitis
Occupational Injuries - etiology
Occupational Injuries - pathology
Occupational Injuries - therapy
Pain
Plastic surgery
Practice
Skin
Streptococcus pyogenes
Surgery
Work related injuries
Wound healing
Wounds, Stab - microbiology
Wounds, Stab - pathology
Wounds, Stab - therapy
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Summary:A 44-year-old pathologist presented to the emergency department after sustaining a scalpel injury during a postmortem examination 16 hours previously. He had stabbed the dorsum of his left thumb overlying the interphalangeal joint and immediately irrigated the wound with water. At the time of presentation, he felt feverish, and had erythema and severe pain in his thumb. He was previously healthy, and did not smoke or have any known allergies. He was not taking any medications. Diagnosis may be challenging as there are no distinct identifying signs. Scoring systems such as the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score were developed to aid early recognition; however, necrotizing fasciitis has been identified in cases with a LRINEC score of 0. It is important to be clinically alert to the condition, regardless of LRINEC scores, and to seek early expert advice when necrotizing fasciitis is suspected. Magnetic resonance imaging has been studied extensively as an aid to diagnosis but its use remains controversial.
ISSN:0820-3946
1488-2329
DOI:10.1503/cmaj.161386