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Intravenous immunoglobulin in necrotizing fasciitis - A case report and review of recent literature.

Koch C, Hecker A, Grau V, Padberg W, Wolff M, Henrich M - Ann Med Surg (Lond) (2015)

Bottom Line: Despite intense microbiological diagnosis, no causative pathogens were identified.After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition.NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany.

ABSTRACT

Introduction: Necrotizing fasciitis (NF) is an inflammatory disease of the soft tissue, which causes local tissue destruction and can lead to lethal septic shock. The therapy consists of early surgical treatment of the septic focus and an accompanying broad spectrum antibiotic therapy. Recent literature considers the additional use of immunoglobulin therapy in severe soft skin and tissue infections.

Presentation of case: In this report, we describe the case of a 33-year-old male patient treated at a university hospital intensive care unit because of an NF of his left leg. The patient rapidly developed a complicated septic disease after a minor superficial trauma. Despite intense microbiological diagnosis, no causative pathogens were identified. After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition.

Discussion: NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%). Beside the surgical debridement and broad spectrum antibiotic therapy IVIg therapy might be an additional option in the treatment of NF. But the current literature supporting the use of IVIG in NF is largely based on retrospective or case-controlled studies, and only small randomized trials.

Conclusion: The demonstrated case suggests that IVIg treatment of patients with NF can be considered in case of hemodynamic unstable, critically ill patients. Although randomized controlled trials are missing, some patients might benefit from diminishing hyperinflammation by immunoglobins.

No MeSH data available.


Related in: MedlinePlus

Left lower leg at day 3 after admission.
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fig1: Left lower leg at day 3 after admission.

Mentions: On hospital admission, the patient was awake, oriented and in stable respiratory and circulatory condition. During the clinical examination, his temperature was 37.2 °C, his blood pressure was 171/85 mmHg, pulse 140 beats per minute, rhythmic and his initial oxygen saturation checked by pulse oximetry was 95% in room air. He was somnolent but easily aroused and on examination presented. Secondary findings in physical examination were severe pain and swellings in both axillae and in both groins. A laboratory evaluation revealed an increase in white blood cell (WBC) count (23.1 × 103/μL; reference value 4.00 to 11.00 × 103/μL), and C-reactive protein (CRP) 298.8 mg/dL (reference value 0.0–0.5 mg/dL). On the day of admission and the day after admission, we immediately performed surgical wound excisions with large debridement in the infected area of the left lower leg (Fig. 1). Due to international recommendations [14–16] and the current antibiotic guidelines at our hospitals intensive care unit (ICU), empirical antibiotic therapy was changed to Meropenem (4 × 1000 mg/d), Penicillin G (6x 5 Mega I.E./d) and Clindamycin (3 × 600 mg/d).


Intravenous immunoglobulin in necrotizing fasciitis - A case report and review of recent literature.

Koch C, Hecker A, Grau V, Padberg W, Wolff M, Henrich M - Ann Med Surg (Lond) (2015)

Left lower leg at day 3 after admission.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539184&req=5

fig1: Left lower leg at day 3 after admission.
Mentions: On hospital admission, the patient was awake, oriented and in stable respiratory and circulatory condition. During the clinical examination, his temperature was 37.2 °C, his blood pressure was 171/85 mmHg, pulse 140 beats per minute, rhythmic and his initial oxygen saturation checked by pulse oximetry was 95% in room air. He was somnolent but easily aroused and on examination presented. Secondary findings in physical examination were severe pain and swellings in both axillae and in both groins. A laboratory evaluation revealed an increase in white blood cell (WBC) count (23.1 × 103/μL; reference value 4.00 to 11.00 × 103/μL), and C-reactive protein (CRP) 298.8 mg/dL (reference value 0.0–0.5 mg/dL). On the day of admission and the day after admission, we immediately performed surgical wound excisions with large debridement in the infected area of the left lower leg (Fig. 1). Due to international recommendations [14–16] and the current antibiotic guidelines at our hospitals intensive care unit (ICU), empirical antibiotic therapy was changed to Meropenem (4 × 1000 mg/d), Penicillin G (6x 5 Mega I.E./d) and Clindamycin (3 × 600 mg/d).

Bottom Line: Despite intense microbiological diagnosis, no causative pathogens were identified.After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition.NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany.

ABSTRACT

Introduction: Necrotizing fasciitis (NF) is an inflammatory disease of the soft tissue, which causes local tissue destruction and can lead to lethal septic shock. The therapy consists of early surgical treatment of the septic focus and an accompanying broad spectrum antibiotic therapy. Recent literature considers the additional use of immunoglobulin therapy in severe soft skin and tissue infections.

Presentation of case: In this report, we describe the case of a 33-year-old male patient treated at a university hospital intensive care unit because of an NF of his left leg. The patient rapidly developed a complicated septic disease after a minor superficial trauma. Despite intense microbiological diagnosis, no causative pathogens were identified. After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition.

Discussion: NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%). Beside the surgical debridement and broad spectrum antibiotic therapy IVIg therapy might be an additional option in the treatment of NF. But the current literature supporting the use of IVIG in NF is largely based on retrospective or case-controlled studies, and only small randomized trials.

Conclusion: The demonstrated case suggests that IVIg treatment of patients with NF can be considered in case of hemodynamic unstable, critically ill patients. Although randomized controlled trials are missing, some patients might benefit from diminishing hyperinflammation by immunoglobins.

No MeSH data available.


Related in: MedlinePlus