title: [A case of successful medical treatment for necrotizing fasciitis of the chest wall with diabetic nephropathy].
abstract: A 52-year-old man was given a diagnosis of type 2 diabetes mellitus at age 39. At age 46, he stopped taking medication. Two weeks after burning his legs at low temperature, he fell, using his right arm to protect his legs. The next day, he complained of pain and slight swelling from his right shoulder to his anterior chest and came to our hospital. At that time, a plain computed tomography scan suggested gasogenic bacterial infection and we discussed the indications for debridment. Although his widespread inflammation required extensive treatment including thoracostomy, we abandoned surgical treatment and administered several antibiotics in appropriate combination because of his severe condition. After admission, the mass grew rapidly and it was diagnosed as necrotizing fasciitis based on percutaneous needle biopsy and clinical findings. Although both inflammatory reactions and mass size tended to improve, he had repeated recurrence of pain and swelling in his right anterior chest. When he had a second recurrence, he received additional short-term steroid therapy. Afterwards he had no further recurrence. In this case, early clinical diagnosis, using broad-spectrum antibiotics prior to definite diagnosis, and additional short-term steroid therapy at the time of the recurrence were effective.
authors.affiliation: Department of Respiratory Medicine, Takatsuki Red Cross Hospital.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Yasuba
authors.forename: Kenzo
authors.initials: K
authors.lastname: Yamashita
authors.forename: Hideo
authors.initials: H
authors.lastname: Kita
authors.forename: Wataru
authors.initials: W
authors.lastname: Chiba
authors.forename: Shigeki
authors.initials: S
authors.lastname: Hitomi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015377:Cilastatin / Q000008:administration & dosage; D000077728:Cilastatin, Imipenem Drug Combination; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications*; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage; D013845:Thienamycins / Q000008:administration & dosage; D035441:Thoracic Wall; D014057:Tomography, X-Ray Computed; D015091:beta-Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D013845:Thienamycins; D015091:beta-Alanine; C075316:panipenem-betamipron; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D008911:Minocycline