ABSTRACT
Necrotizing fasciitis is a soft tissue infection uncommonly described in children and is associated with significant morbidity and mortality if not treated early and aggressively. Reports of cases involving the upper torso are rare in general. In adults, necrotizing fasciitis is most commonly described in the abdomen, perineum, and extremities. For children, particularly neonates, necrotizing fasciitis most commonly involves the trunk presenting as omphalitis. In this report, we describe 2 pediatric cases of necrotizing fasciitis of the chest wall that presented within 6 months from each other at Los Angeles County Hospital/University of Southern California Pediatric Emergency Department. Both cases involved previously healthy children with above normal body mass indices of 36 and 25.6, respectively. These cases are noteworthy because of the rarity of necrotizing fasciitis among children especially in the chest wall, atypical presentation with nonspecific symptoms which made the diagnosis challenging, and suggestion that obesity may be a potential risk factor. Despite the rarity of this disease, the information presented in these cases may aid in raising the index of suspicion for diagnosis of necrotizing fasciitis.
Subject(s)
Fasciitis, Necrotizing/diagnosis , Soft Tissue Infections/diagnosis , Thoracic Wall/microbiology , Thoracic Wall/pathology , Child , Diagnosis, Differential , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/pathology , Female , Humans , Male , Risk Factors , Soft Tissue Infections/microbiology , Soft Tissue Infections/pathology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/pathology , Staphylococcus aureus/isolation & purification , Streptococcal Infections/diagnosis , Streptococcal Infections/pathology , Streptococcus pyogenes/isolation & purificationABSTRACT
Infective endocarditis is a challenging diagnosis that is rarely made in the emergency department. As the use of focused emergency ultrasound expands into more applications, including advanced echocardiography, the diagnosis of infective endocarditis may be made earlier, potentially leading to more timely treatment. We report a case of an ill-appearing patient presenting to the emergency department with an indwelling central venous catheter, a cardiac murmur, and necrotic toes, who was diagnosed with a large tricuspid vegetation and prominent tricuspid regurgitation on bedside emergency ultrasound. A cardiologist-performed echocardiogram confirmed these findings during the patient's hospital admission.
