Drug Injection Induced Extensive Necrotizing Fasciitis-A Case Report and Literature Review

藥物注射引發之廣泛性壞死性筋膜炎－病例報告與文獻回顧

潘致皓(Chih-Hao Pan) ； 尤傑銘(Chieh-Ming Yu) ； 歐聖運(Shuan-Yuan Ou) ； 董光義(Kwang-Yi Tung) ； 黃文成(Wen-Chen Huang) ； 游家孟(Chia-Meng Yu) ； 蔡明峰(Ming-Feng Tsai) ； 姚文騰(Wen-Teng Yao) ； 陳昱帆(Yu-Fan Chen)

《臺灣整形外科醫學會雜誌》 30卷2期 (2021/06) Pp. 95-100

摘要

Background: Necrotizing fasciitis is a rapidly progressive infection involving the subcutaneous tissue and fascia. It is also a severe manifestation of cutaneous complications in injection drug users. The mortality of necrotizing fasciitis remains high (20% - 80%), making early diagnosis and surgical intervention particularly pivotal. Aim and Objectives: We present a case of necrotizing fasciitis of the right upper limb, chest, and abdominal wall due to drug injection in an attempt to highlight the importance of early diagnosis and timely surgical intervention for necrotizing fasciitis in injection drug users. Materials and Methods: A 41-year-old man with heroin addiction presented at the emergency department with erythema and swelling over the right upper arm, which was around his drug injection site, which rapidly progressed to the right side of the axilla, chest, and abdominal wall. Locoregional cellulitis and skin necrosis were also observed in the left upper limb, which was considered as another drug injection site. Prevotella nigrescens was repeatedly identified from the culture of the infected area. Gram-negative anaerobes are usually isolated from polymicrobial infections of periodontal origin and are seldom reported as extraoral infections. He underwent emergent fasciotomy and was subsequently diagnosed with necrotizing fasciitis. Afterward, he had several debridements, wound dressing, and antibiotic treatment synchronously. Results: The infection was gradually controlled. Skin grafting and stepwise delayed primary closure were performed for the viable wound. He recovered and was discharged after 40 days of hospitalization. Conclusion: We present this case to highlight the importance of early diagnosis and timely surgical intervention for necrotizing fasciitis in injection drug users, and reveal a singular microbial result identified from necrotizing soft tissue infection.

關鍵字

Drug abuser ； Necrotizing fasciitis ； Prevotella nigrescens

並列摘要

背景：壞死性筋膜炎係一透過皮下與筋膜層快速擴展之嚴重的感染病。同時也是藥物濫用者族群中注射處感染可能衍生出的嚴重併發症之一。高死亡率（20%－80%）凸顯出壞死性筋膜炎早期診斷及手術治療的重要性。目的及目標：藉由一藥物注射引發之右側上肢、胸部、腹部壞死性筋膜炎之病例報告與相關文獻探討，彰顯針對藥物濫用者族群可能引發的壞死性筋膜炎，早期診斷與手術治療的重要性。材料及方法：病例報告：一位41歲男性之靜脈注射海洛英成癮者至急診求治。主訴為右上臂紅熱腫痛，且在一周內擴及右胸及腹壁處。且病人的左上臂亦有局部性紅熱腫痛，疑似蜂窩性組織炎之症狀。病人坦承近期仍有經雙上臂與肘窩處注射海洛英，其感染原發部位和藥物注射處相符合。傷口細菌培養報告為Prevotella nigrescens；是一種常發生於牙周以及口腔內感染之格蘭氏陰性厭氧菌，此菌種極少發生於口腔外感染。因為有壞死性筋膜炎的疑慮，病人快速接受緊急筋膜切開術，術中確診為壞死性筋膜炎。病人接受多次的傷口清創、傷口照護以及抗生素治療。結果：感染逐漸獲得控制。病人接受植皮與延遲傷口關閉等階段性的傷口重建後復原良好。於術後40天後出院。結論：口腔內菌種導致壞死性筋膜炎之案例於過去文獻鮮少被提及。藉由此案例我們強調藥物注射成癮者，於注射處感染引發壞死性筋膜炎，其及時診斷於手術治療的重要性，也呈現一罕見的致病菌種。