[Extremity gangrene caused by rare co-infection of multiple bacteria: a case report].
Because of progressive infectious necrosis on right hand and forearm for 3 months and the necrosis on left mid-finger for 2 months, a girl patient, Yang Xiaoxia was admitted on 15th, Nov. 1994. Systemic intoxicative symptom was slight and the necrotic tissue presented black scar. After 3 months treatment by application of multiple antibiotics, local dressing changes and an amputation of right froearm, the necrosis could not be stopped but keeping deteriorating. Through experts' consultation, systemic surpportive therapy, wide-spectrum antibiotics cilastatin sodium and complete debridement were adopted. One week later, the fresh surface of granulation tissue was seen, and skin grafting was performed. The wound healed 3 months later. After further rehabilitation, the left thumb, index and fifth finger showed normal function. A mechanical motional artificial limb was installed on right forearm and discharged. The deep necrotic tissue of left mid-finger was examined. Results of culture from several hospital presented 2 kinds of aerobic bacteria and 10 kinds of the anaerobic, of which, the names of 3 kinds are still unknown. Pathological examination showed chronic pyogenic necrotic infection, spreading from skin to deep muscles and interosseous membrane. And infiltration of eosinophilic granulocytes was found in the infectious region.


CONCLUSIONS
This patients is progressive gangrene of the extremity caused by rare co-infection of multiple bacteria. The characteristics were slight systemic intoxicative symptom, local progressive necrosis and formation of black scar. By means of systemic surpportive therapy, application of wide-spectrum antibiotics cilastatin sodium, complete debridement and skin grafting, the patient was cured.
Liu
S
S
General Hospital, Beijing Military command.
Wang
D
D
Li
J
J
Xu
S
S
D000293:Adolescent; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001420:Bacteria, Aerobic; D001421:Bacteria, Anaerobic; D001424:Bacterial Infections / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D015377:Cilastatin / Q000627:therapeutic use*; D003646:Debridement; D005260:Female; D005542:Forearm / Q000473:pathology*; D005734:Gangrene; D006801:Humans; D011480:Protease Inhibitors / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D011480:Protease Inhibitors; D015377:Cilastatin