title: Five cases of necrotizing fasciitis: lack of skin inflammatory signs as a clinical clue for the fulminant type.
abstract: Herein, we describe five patients with necrotizing fasciitis (NF) who had variable outcomes and clinical manifestations. At the onset, all patients exhibited purpura with or without blister and ulceration accompanied by severe pain and tenderness in the affected skin. Out of five patients, three lacked inflammatory signs such as redness and heat, and two of the three patients showed fulminant progression and died despite intensive treatments including surgical debridement, antimicrobial therapy, close monitoring and physiological support. Tissue specimens from the patients without skin inflammatory signs showed mild neutrophil infiltration in addition to necrosis from the epidermis to subcutaneous fat, and variable amounts of thrombi. Furthermore, numerous bacteria were detected by Gram stain. By contrast, the remaining two patients with skin inflammatory signs revealed slower progression, and tissue specimens from both patients showed heavy neutrophil infiltration, but bacteria were hardly detected. Therefore, these cases suggest the possibility that the paucity of skin inflammatory signs, such as redness and heat, in NF may be a clinical clue to predict the fulminant type.
authors.affiliation: Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. iwayou@msn.com
authors.forename: Yohei
authors.initials: Y
authors.lastname: Iwata
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sato
authors.forename: Yumi
authors.initials: Y
authors.lastname: Murase
authors.forename: Ayuko
authors.initials: A
authors.lastname: Iijima
authors.forename: Kaori
authors.initials: K
authors.lastname: Hayashi
authors.forename: Sakae
authors.initials: S
authors.lastname: Murakami
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Usuda
mesh_terms: D003872:Dermatitis / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000145:classification / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012611:Scrotum / Q000473:pathology; D012867:Skin / Q000473:pathology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D034941:Upper Extremity / Q000473:pathology; D014735:Vibrio Infections / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy