Endocrine Abstracts

Introduction: Necrotizingfasciitis is a severe infection of deep subcutaneous tissue and hypodermal fascia with secondary skin necrosis.

Observation: Patient M.A., aged 67, with no particular pathological history, presented with an 11-day history of a boil on the left forearm, treated with traditional herbs. The evolution was marked by the development of an inflammatory placard on the forearm with extensive necrotic lesions. Ultrasound revealed extensive infiltration of the soft tissue, organized into micro and macro logettes. Biological findings included a predominantly neutrophilic hyperleukocytosis, CRP 406 mg/l, and bacteriological sampling of the pus isolated multi-sensitive Pseudomonas aeruginosa. With the onset of edema and insomniac pain, the investigation was completed by a venous echodoppler of the left upper limb, which revealed thrombophlebitis of the ulnar vein. The patient underwent necrosectomy. Treatment consisted of curative anticoagulation, intensified insulin therapy and strict glycemic control. Triple intravenous probabilistic antibiotic therapy was instituted, then adapted to the antibiogram. The evolution was favorable, with a good clinico-biological improvement and good directed healing.

Discussion and conclusion: Necrotizing fasciitis of the upper limbs remains a relatively rare infection. It can occur at any age, although advanced age is considered a risk factor. Necrotizing fasciitis is a major medical and surgical emergency, and the rapidity of its evolution makes it essential to establish the diagnosis as soon as possible, in order to reduce the risk of mortality and disabling functional sequelae. Clinically, differentiating a necrotizing infection from a common soft-tissue infection is difficult when cutaneous necrosis does not dominate the clinical presentation. The germs responsible are varied (frequently streptococci, multi-microbial flora in over half of cases). It requires early, intensive management based on three pillars (early surgical excision, broad-spectrum antibiotic therapy and resuscitation) in parallel with strict glycemic control. The prognosis is clouded by the severity of lesions and delays in treatment. Prevention must be encouraged through effective patient education, with targets to be set consistently.