Limits...
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

CT Image at day 3 after admission showing lung oedema, pleural effusions, compression atelectasis of both lower lung lobes, and dorsal superior lobes. Ventilated areas showing focal and lobular oedema, and thickening of the interlobular septa.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4539184&req=5

fig2: CT Image at day 3 after admission showing lung oedema, pleural effusions, compression atelectasis of both lower lung lobes, and dorsal superior lobes. Ventilated areas showing focal and lobular oedema, and thickening of the interlobular septa.

Mentions: For further diagnostics, tissue samples and swabs from all infected areas were taken intraoperatively. Blood cultures were also taken at different time points. But no causative pathogen could be identified. Because of further increased inflammation markers and clinical deterioration, the anti-infective therapy was supplemented by Levofloxacin (2 × 500 mg/d) and Daptomycin (1000 mg loading-dose, 500 mg/d) for the coverage of methicillin-sensitive S. aureus and atypical pathogens two days after hospital admission. Caspofungin (70 mg loading-dose, 50 mg/d) was also added to cover invasive fungal infections. On the third day after admission, a hole-body computed tomography scan was performed. The result showed a fasciitis of the left upper and lower leg, and a symmetrical bilateral pulmonary oedema. Furthermore, bilateral pleural effusions impressed with basal atelectasis and a generalized barrier disruption. Because of a progredient lung oedema (Fig. 2) and consecutive respiratory dysfunction the patient developed the need for mechanical ventilation.


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)

CT Image at day 3 after admission showing lung oedema, pleural effusions, compression atelectasis of both lower lung lobes, and dorsal superior lobes. Ventilated areas showing focal and lobular oedema, and thickening of the interlobular septa.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

fig2: CT Image at day 3 after admission showing lung oedema, pleural effusions, compression atelectasis of both lower lung lobes, and dorsal superior lobes. Ventilated areas showing focal and lobular oedema, and thickening of the interlobular septa.
Mentions: For further diagnostics, tissue samples and swabs from all infected areas were taken intraoperatively. Blood cultures were also taken at different time points. But no causative pathogen could be identified. Because of further increased inflammation markers and clinical deterioration, the anti-infective therapy was supplemented by Levofloxacin (2 × 500 mg/d) and Daptomycin (1000 mg loading-dose, 500 mg/d) for the coverage of methicillin-sensitive S. aureus and atypical pathogens two days after hospital admission. Caspofungin (70 mg loading-dose, 50 mg/d) was also added to cover invasive fungal infections. On the third day after admission, a hole-body computed tomography scan was performed. The result showed a fasciitis of the left upper and lower leg, and a symmetrical bilateral pulmonary oedema. Furthermore, bilateral pleural effusions impressed with basal atelectasis and a generalized barrier disruption. Because of a progredient lung oedema (Fig. 2) and consecutive respiratory dysfunction the patient developed the need for mechanical ventilation.

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