Necrotizing Fasciitis? A Mimic Produced by an Unusual Presentation of Necrotizing Neutrophilic Dermatosis of the Hand

Abstract

Case: A 50-year-old woman presented to our emergency department with hand pain and a laceration. Despite administration of antibiotics, the patient progressively worsened leading to a concern for a necrotizing soft-tissue infection. She underwent multiple debridements yet continued to worsen clinically. Tissue biopsy was eventually consistent with a necrotizing neutrophilic dermatosis. The patient was then started on oral steroids with rapid improvement of her clinical status and hand examination. Conclusion: While neutrophilic dermatoses are rare, the orthopaedic surgeon treating soft-tissue infections should maintain a broad differential when treatment of a potential necrotizing infection has not led to diagnostic closure and clinical improvement.