title: A case of necrotizing fasciitis with a LRINEC score of zero: clinical suspicion should trump scoring systems.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis.
  
  
  OBJECTIVE
  The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed.
  
  
  METHODS
  A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery.
  
  
  CONCLUSIONS
  Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score.
authors.affiliation: Department of Emergency Medicine, UC San Diego Health System, San Diego, California, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wilson
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Schneir
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D003404:Creatinine / Q000032:analysis; D004636:Emergency Service, Hospital; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D018570:Risk Assessment / Q000379:methods*; D012964:Sodium / Q000032:analysis; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose; D006454:Hemoglobins; D019344:Lactic Acid; D002097:C-Reactive Protein; D012964:Sodium; D003404:Creatinine