title: Subacute necrotizing fasciitis caused by gas-producing Staphylococcus aureus.
abstract: Presented here is a case of necrotizing fasciitis that developed bilaterally on the thighs of a 54-year-old diabetic woman following subcutaneous insulin injection. Severe localized pain was the presenting symptom; later, soft-tissue gas appeared. Incisional biopsy, performed on day 10 following admission, confirmed the diagnosis. Staphylococcus aureus was the only pathogen isolated. The disease had a slowly progressive course despite appropriate medical treatment, and recovery of the patient was achieved only after fasciotomy, drainage, and debridement of necrotic tissue was undertaken 4 weeks following admission. Staphylococcus aureus may cause subacute necrotizing fasciitis, and infection with this organism should be considered in cases of soft-tissue infection with gas formation in diabetics. The development of soft-tissue infection at the site of insulin injection should alert physicians to the possibility of infection with Staphylococcus aureus.
mesh_terms: D000900:Anti-Bacterial Agents; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D004487:Edema / Q000209:etiology; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005740:Gases; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage; D008875:Middle Aged; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000378:metabolism*; D013848:Thigh; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005740:Gases; D007328:Insulin