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      Fournier’s Gangrene in a Female Diabetic Patient: A Case Report

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          Abstract

          Necrotizing fasciitis is a rare but potentially fatal deep infection involving subcutaneous tissue and fascia. The infection can occur in all parts of the body and can cause acute onset pain, swelling, fever, malaise, and tachycardia with or without evidence of skin inflammation. Risk factors include recent surgery, diabetes, trauma, intravenous drug use, alcoholism, and chronic illnesses. This case involves a 35-year-old female with a past medical history of hypertension, type II diabetes mellitus, and obesity presenting with a painful vulvar lump, which progressed rapidly into extensive necrotizing soft tissue infection despite the incision and drainage of the vulvar abscess, marsupialization, and antibiotic therapy. The patient underwent multiple surgical debridements with intense medical treatment and wound vacuum-assisted closure therapy. Uncontrolled diabetes and obesity significantly increase the risk of necrotizing fasciitis. Fournier’s gangrene should be suspected in patients with comorbid conditions and a presentation of a urogenital abscess. This case highlights the importance of prompt diagnosis and treatment of necrotizing fasciitis in a timely manner.

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          Most cited references15

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          Necrotizing fasciitis.

          To describe the defining characteristics and treatment of necrotizing fasciitis (NF), emphasizing early diagnostic indications. PubMed was searched using the terms necrotizing fasciitis and necrotizing soft tissue infections, paired with early diagnosis. Results were limited to human studies in English. Additional articles were obtained from references within articles. Evidence is levels II and III. Necrotizing fasciitis is classified according to its microbiology (polymicrobial or monomicrobial), anatomy, and depth of infection. Polymicrobial NF mostly occurs in immunocompromised individuals. Monomicrobial NF is less common and affects healthy individuals who often have a history of trauma (usually minor). Patients with NF can present with symptoms of sepsis, systemic toxicity, or evidence of skin inflammation, with pain that is disproportional to the degree of inflammation. However, these are also present in less serious conditions. Hyperacute cases present with sepsis and quickly progress to multiorgan failure, while subacute cases remain indolent, with festering soft-tissue infection. Because the condition is rare with minimal specific signs, it is often misdiagnosed. If NF is suspected, histology of tissue specimens is necessary. Laboratory and radiologic tests can be useful in deciding which patients require surgical consultation. Once NF is diagnosed, next steps include early wound debridement, excision of nonviable tissue, and wide spectrum cover with intravenous antibiotics. Necrotizing fasciitis is an uncommon disease that results in gross morbidity and mortality if not treated in its early stages. At onset, however, it is difficult to differentiate from other superficial skin conditions such as cellulitis. Family physicians must have a high level of suspicion and low threshold for surgical referral when confronted with cases of pain, fever, and erythema.
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            Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature.

            Introduction Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. Methods A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. Results After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. Conclusions The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.
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              Fournier's gangrene and its emergency management.

              A. Thwaini (2006)
              Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                16 January 2022
                January 2022
                : 14
                : 1
                : e21293
                Affiliations
                [1 ] Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [2 ] Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [3 ] General Surgery, West Suburban Medical Center, Chicago, USA
                Author notes
                Enkhmaa Luvsannyam luvsenkh@ 123456isu.edu
                Article
                10.7759/cureus.21293
                8846449
                35186555
                f112495f-ecbe-4c77-844d-bbb0dd94e197
                Copyright © 2022, Luvsannyam et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 December 2021
                : 16 January 2022
                Categories
                General Surgery
                Infectious Disease

                obesity,diabetes,soft tissue infection,fournier’s gangrene,necrotizing fasciitis

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