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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

Laboratory characteristics and need for vasopressor-therapy. A: Absolute values of C-reactive protein, CRP (mg/l) and white blood cell count, WBC (giga/l) during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg). B: Absolute values of procalcitonin, PCT (μg/l) and norepinephrine dose, NE (μg/min) as surrogate for the need for hemodynamic support during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg).
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fig3: Laboratory characteristics and need for vasopressor-therapy. A: Absolute values of C-reactive protein, CRP (mg/l) and white blood cell count, WBC (giga/l) during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg). B: Absolute values of procalcitonin, PCT (μg/l) and norepinephrine dose, NE (μg/min) as surrogate for the need for hemodynamic support during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg).

Mentions: CRP, WBC and pro-calcitonin dropped over the next days, and the need for hemodynamic support was significantly reduced (e.g. norepinephrine dose) (Fig. 3). At day 10, vacuum assisted wound closure was used to improve the wound conditions of the left lower leg and both axillae. 32 days after hospital admission, the patient could be moved from the ICU to the primary care station. Local wound conditions recovered and wounds were closed at day 39 using split-skin graft from the right thigh. At day 48 after hospital admission, the patient left the hospital in good general condition. During a follow-up examination, 6 month later, the patient was healthy and we found sufficient wound conditions.


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)

Laboratory characteristics and need for vasopressor-therapy. A: Absolute values of C-reactive protein, CRP (mg/l) and white blood cell count, WBC (giga/l) during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg). B: Absolute values of procalcitonin, PCT (μg/l) and norepinephrine dose, NE (μg/min) as surrogate for the need for hemodynamic support during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

fig3: Laboratory characteristics and need for vasopressor-therapy. A: Absolute values of C-reactive protein, CRP (mg/l) and white blood cell count, WBC (giga/l) during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg). B: Absolute values of procalcitonin, PCT (μg/l) and norepinephrine dose, NE (μg/min) as surrogate for the need for hemodynamic support during intensive care unit treatment. The arrow indicates the initiation of immunogloblin treatment (IVIg).
Mentions: CRP, WBC and pro-calcitonin dropped over the next days, and the need for hemodynamic support was significantly reduced (e.g. norepinephrine dose) (Fig. 3). At day 10, vacuum assisted wound closure was used to improve the wound conditions of the left lower leg and both axillae. 32 days after hospital admission, the patient could be moved from the ICU to the primary care station. Local wound conditions recovered and wounds were closed at day 39 using split-skin graft from the right thigh. At day 48 after hospital admission, the patient left the hospital in good general condition. During a follow-up examination, 6 month later, the patient was healthy and we found sufficient wound conditions.

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