Spontaneous necrotizing soft-tissue infections in patient with diabetes: Case report

Abstract

Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens the prognosis; hence, there is a limited role for additional imaging in critically ill patients. In addition, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Moreover, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI.