Rachel Mullins
University of MIssissippi Medical Center
Jackson, MS
Disclosure information not submitted.
Title: Fatal Outcome of Necrotizing Fasciitis due to Aeromonas species with associated Bacteremia
Introduction: Necrotizing fasciitis (NF) is a rare bacterial infection of the soft tissue. It can be caused by many organisms and is more prevalent in conditions that suppress the immune system. It can lead to sepsis, multiorgan failure, and even death. Typical signs are fever, crepitus, bullous changes and visible skin necrosis and these may progress quickly. It is usually fatal in cases where there is delay in diagnosis and surgical intervention. Here, we report a rapidly fatal case of Aeromonas-associated NF.
Description: A 63-year-old male with hypertension and untreated cutaneous lupus presented with left hand pain after a fall from his bike. He was afebrile with heart rate of 70 bpm and blood pressure was 104/74mmHg. The hand and wrist appeared edematous without erythema or crepitus. A small 1 cm abrasion was noted at the base of his thumb. Bilateral upper extremities revealed scattered hypopigmented lesions and scaling. Lab work was remarkable for creatinine of 3.9, platelets 24,000 and white blood cell count of 9.0. X-rays of left hand revealed soft tissue edema but no gas or fracture. Twelve hours later, the edema was slightly worse and a 2 cm bullous lesion on the dorsal surface of the hand had developed. CT of left arm did not show gas. He remained afebrile with stable vitals. Four hours later, the patient’s mental status deteriorated, and a rapid response was called. The entire arm was now swollen with degloving of the hand. Surgery planned to operate immediately, but the patient developed cardiac arrest. He lost his pulse and ACLS was performed for twenty minutes without achievement of ROSC, and he subsequently expired. Blood cultures resulted posthumously and were positive for Aeromonas species.
Discussion: Aeromonas is one of many organisms that can cause NF and is important to recognize and treat quickly. It may or may not produce gas on imaging, therefore it is important to have a high suspicion for Aeromonas, especially in immunocompromised patients. In this group, a diagnosis of NF can be challenging due to lack of initial systemic response. This can lead to rapid, advanced infection leading to death. A practice-changing learning point for our team was that NF requires prompt and accurate diagnosis, antibiotic therapy, and surgical intervention to avoid detrimental outcomes.