Display options
Cite
Brumann M, Bogner V, Völkl A, et al. Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge. Patient Saf Surg. 2014;8:28doi: 10.1186/1754-9493-8-28.
Brumann, M., Bogner, V., Völkl, A., Sotlar, K., Euler, E., & Mutschler, W. (2014). Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge. Patient safety in surgery, 828. https://doi.org/10.1186/1754-9493-8-28
Brumann, Mareen, et al. "Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge." Patient safety in surgery vol. 8 (2014): 28. doi: https://doi.org/10.1186/1754-9493-8-28
Brumann M, Bogner V, Völkl A, Sotlar K, Euler E, Mutschler W. Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge. Patient Saf Surg. 2014 Jun 26;8:28. doi: 10.1186/1754-9493-8-28. eCollection 2014. PMID: 25002906; PMCID: PMC4084793.
Copy Download .nbib Format: NLM
Share it on

Patient Saf Surg. 2014 Jun 26;8:28. doi: 10.1186/1754-9493-8-28. eCollection 2014.

Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge.

Patient safety in surgery

Mareen Brumann, Viktoria Bogner, Andreas Völkl, Karl Sotlar, Ekkehard Euler, Wolf Mutschler

Affiliations

  1. Department of Trauma Surgery, University Hospital Munich, Ludwig-Maximilians-University, Nussbaumstr. 20, Munich 80336, Germany.
  2. Department of Hematology and Oncology, University Hospital Munich, Ludwig-Maximilians-University, Ziemsenstr. 1, Munich 80336, Germany.
  3. Institute of Pathology, University Hospital Munich, Ludwig-Maximilians-University, Thalkirchnerstr. 36, Munich 80337, Germany.

PMID: 25002906 PMCID: PMC4084793 DOI: 10.1186/1754-9493-8-28

Abstract

BACKGROUND: Necrotizing fasciitis is characterized by a fulminant destruction of the soft tissue with an alarmingly high mortality rate. One of the main reasons for the continued high mortality is due to the challenge to punctual recognize and diagnose this disease, as specific cutaneous signs can vary or even be missing early in its evolution - especially in case of simultaneous first manifestation of an acute leukemia.

CASE PRESENTATION: An untypical case of necrotizing fasciitis disease in a young patient with the first diagnosis of acute myeloid leukemia is presented. After her induction chemotherapy the only presenting clinical sign was fever in the presence of severe neutropenia without an evident infectious focus. After a few days a painless confluent, erythematous, pustular skin rash with a central necrosis on lateral thigh appeared. Escherichia coli was isolated from blood cultures. Surgical debridement was performed and showed subcutaneous tissue, fascia and underlying muscle around the site of initial cutaneous manifestation with typical necrosis on exploration. But, initially taken skin biopsy did not show any typical histopathological findings like bacteria or inflammatory cells confirming necrotizing fasciitis. Nevertheless, the intraoperative findings were impressive and highly indicative for a necrotizing soft tissue infection, so that the patient was treated according to clinical guidelines with extensive recurrent surgical debridement, broad-spectrum antibiotics and intensive care therapy. After recovering from NF, she successfully underwent further chemotherapy and stem cell transplantation.

CONCLUSION: The presented case highlights the risk of potential misinterpretation, delayed diagnosis and treatment of necrotizing fasciitis in patients presenting with an untypical clinical and histopathological manifestation of necrotizing fasciitis as a result of severe neutropenia following chemotherapy for acute myeloid leukemia.

Keywords: Acute myeloid leukemia; Diagnostic difficulties; Granulocytopenia; Necrotizing fasciitis; Soft tissue infection

References

  1. Ann Acad Med Singap. 1990 Mar;19(2):290-4 - PubMed
  2. Surg Clin North Am. 1975 Dec;55(6):1289-96 - PubMed
  3. Am J Med. 1998 Jan;104(1):48-55 - PubMed
  4. N Engl J Med. 1991 Jul 18;325(3):164-70 - PubMed
  5. Ann Hematol. 2011 Feb;90(2):235-8 - PubMed
  6. Am Surg. 2002 Feb;68(2):109-16 - PubMed
  7. Med Microbiol Immunol. 2000 Jun;188(4):169-75 - PubMed
  8. Ann Surg. 1996 Nov;224(5):672-83 - PubMed
  9. Can Fam Physician. 2009 Oct;55(10):981-7 - PubMed
  10. J Trauma Acute Care Surg. 2012 Mar;72(3):560-6 - PubMed
  11. J Am Coll Surg. 2000 Sep;191(3):227-31 - PubMed
  12. Crit Care Med. 2004 Jul;32(7):1535-41 - PubMed
  13. Lupus. 2006;15(6):380-3 - PubMed
  14. J Am Coll Surg. 2009 Feb;208(2):279-88 - PubMed
  15. Plast Reconstr Surg. 1999 May;103(6):1567-73 - PubMed
  16. Curr Opin Infect Dis. 2005 Apr;18(2):101-6 - PubMed
  17. Unfallchirurg. 2011 Mar;114(3):197-216 - PubMed
  18. J Emerg Med. 1990 May-Jun;8(3):299-304 - PubMed
  19. Arch Surg. 1998 Aug;133(8):812-7; discussion 817-9 - PubMed
  20. Int J Dermatol. 2007 Oct;46(10):1036-41 - PubMed
  21. Ann Surg. 1995 May;221(5):558-63; discussion 563-5 - PubMed
  22. J Bone Joint Surg Am. 2003 Aug;85(8):1454-60 - PubMed
  23. Epidemiol Infect. 2006 Apr;134(2):293-9 - PubMed
  24. World J Surg. 1991 Mar-Apr;15(2):235-9 - PubMed
  25. Am Surg. 1998 May;64(5):397-400; discussion 400-1 - PubMed
  26. Leukemia. 2001 Aug;15(8):1161-4 - PubMed
  27. N Engl J Med. 1984 Jun 28;310(26):1689-93 - PubMed
  28. Am J Emerg Med. 2006 Jan;24(1):58-61 - PubMed
  29. J Pediatr Surg. 1995 Aug;30(8):1131-4 - PubMed

Publication Types