ABSTRACT
Introduction and importance: In approximately 50% of patients with necrotizing fasciitis, infection begins deep in the soft tissues. A history of trauma is often absent. The mechanism of spread has not been elucidated. We report a case of type II necrotizing fasciitis in which the streptococcal strain was identical to isolates from other locations in the same patient. Case presentation: A 42-year-old man presented with left leg pain. Two days prior, he had a non-penetrating injury to the left thigh while playing futsal. Workup revealed swelling of the left gastrocnemius. He was admitted to orthopaedics. On the third hospital day, he was referred to our department for hypotension, impending respiratory failure, and decreased sensorium, and subsequently admitted to the ICU. A biopsy was done on the left gastrocnemius fascia. He was diagnosed with necrotizing fasciitis. On the seventh hospital day, left hip amputation and extensive debridement of the trunk were done. Patient improved and eventually recovered. Clinical discussion: Group A streptococcus was isolated in from the fascia, blood, and pharyngeal ulcer. Pulsed field gel electrophoresis showed all isolates to be genetically identical. An oral route of infection was considered. Conclusions: This is the first report in which etiologic agent of necrotizing fasciitis is genetically identical with isolates from other parts in the absence of trauma.
ABSTRACT
BACKGROUND: Ventricular septal rupture (VSR) secondary to blunt chest trauma is rare and associated with a diverse range of symptoms and clinical courses as well as disease severity. We present a case of traumatic VSR in which rapid progression of heart failure was observed in spite of relatively low pulmonary to systemic blood flow (Qp/Qs) ratio. CASE PRESENTATION: A 40-year-old male was transported to the emergency department approximately 12 h after blunt chest trauma. VSR was diagnosed by echocardiography, and right heart catheterization revealed a Qp/Qs ratio of 1.52. Although medical treatment was initially attempted, subsequent rapid progression of heart failure necessitated emergent surgical repair of VSR. CONCLUSIONS: Because small, asymptomatic VSR often close spontaneously, surgical repair of traumatic VSR is indicated when the shunt rate is relatively large or heart failure is present. However, the present case highlights the need to consider emergent surgical repair of traumatic VSR, even when the shunt rate is relatively small.
