title: Necrotizing fasciitis of the paraspinous muscles.
abstract: Necrotizing fasciitis (NF) is a rare and lethal soft tissue infection that requires urgent surgical intervention. It is most often found in the extremities occurring with precipitating trauma or in immunocompromised states. Signs and symptoms are often vague or missing making early diagnosis very difficult. Our patient presented with flank pain and altered mental status but no known precipitating factors. Computed Tomography showed gas within and around the right paraspinous muscle suspicious for NF. Given NF's high lethality, early suspicion by emergency physicians of NF in patients with soft tissue infections or with systemic findings of unknown etiology is necessary.
authors.affiliation: University of California, Davis School of Medicine.
authors.forename: Denise
authors.initials: D
authors.lastname: Law
authors.forename: Kapil R
authors.initials: KR
authors.lastname: Dhingra
references.citation: Arch Surg. 2005 Feb;140(2):151-7; discussion 158
references.pmid: 15723996
references.citation: Am J Surg. 2007 Dec;194(6):809-12; discussion 812-3
references.pmid: 18005776
references.citation: J Emerg Med. 2008 Jan;34(1):37-40
references.pmid: 17976803
references.citation: Clin Infect Dis. 2007 Mar 1;44(5):705-10
references.pmid: 17278065
references.citation: Am Surg. 2002 Feb;68(2):109-16
references.pmid: 11842952
references.citation: Radiology. 1997 Jun;203(3):859-63
references.pmid: 9169717
references.citation: Crit Care Med. 2004 Jul;32(7):1535-41
references.pmid: 15241098
references.citation: Am J Emerg Med. 2008 Feb;26(2):170-5
references.pmid: 18272096
references.citation: Clin Orthop Relat Res. 2006 Jun;447:179-86
references.pmid: 16672902
references.citation: J Emerg Med. 2008 Feb;34(2):139-46
references.pmid: 17976799
references.citation: Ann Surg. 1987 Nov;206(5):661-5
references.pmid: 3314752
references.citation: Emerg Med J. 2007 Feb;24(2):e8
references.pmid: 17251603
references.citation: Curr Opin Infect Dis. 2005 Apr;18(2):101-6
references.pmid: 15735411
references.citation: J Emerg Med. 2008 May;34(4):457-8
references.pmid: 18022785
references.citation: Curr Opin Crit Care. 2007 Aug;13(4):433-9
references.pmid: 17599015
references.citation: Ann Surg. 1995 May;221(5):558-63; discussion 563-5
references.pmid: 7748037
references.citation: Adv Skin Wound Care. 2007 May;20(5):288-93; quiz 294-5
references.pmid: 17473566
references.citation: Crit Care Med. 2005 Jul;33(7):1677
references.pmid: 16003106
references.citation: J Bone Joint Surg Am. 2003 Aug;85(8):1454-60
references.pmid: 12925624