Commentary Addresses Pitfalls of Diagnosing Necrotizing Fasciitis

Missed or delayed diagnosis of necrotizing fasciitis is common, but early diagnosis and debridement is crucial to patient survival and reduction in morbidity and the need for amputation, according to the authors of a commentary from the July-August 2014 edition of the Agency for Healthcare Research and Quality's online case study review, WebM&M. In the spotlight case, a 49-year-old man presented to the emergency department (ED) with diffuse pain on his left side after falling from his truck at work three days prior. A different ED had already discharged him with a prescription for nonsteroidal anti-inflammatory medications, but his pain was becoming more severe and he could not ambulate independently. Although blood tests showed acute renal insufficiency and a computed tomography scan revealed fluid layering in his abdomen, the trauma surgical service felt that the findings were due to diffuse bruising. The next day, the internal medicine team diagnosed him with rhabdomyolysis from trauma and acute renal failure; however, his pain had become so severe that he required a patient-controlled analgesia pump. As the day progressed, the patient experienced worsening respiratory distress and developed septic shock, requiring an urgent operation to debride a large amount of skin and soft tissue from throughout his body.