title: Community-acquired necrotizing fasciitis caused by Acinetobacter calcoaceticus: a case report and literature review.
abstract: A 61-year-old man presented with pain in the abdomen and right lower limb. He had a history of hepatitis B virus-induced liver cirrhosis, but had not been visiting the outpatient clinic and did not receive any medication. Cutaneous necrosis and bulla were observed on his abdomen and right lower limb. The necrotic skin was incised, and he was diagnosed with necrotizing fasciitis. A nonfermentative Gram-negative bacillus infection was confirmed from aspirated fluid and blood cultures. Therefore, meropenem and immunoglobulins were administered. Because necrosis was widespread, surgical debridement was performed. Thereafter, Acinetobacter calcoaceticus infection was confirmed by semi-quantitative PCR using the bullous fluid and blood cultures. Meropenem was administered for 3 weeks, followed by levofloxacin alone for 1 week. The patient's condition improved; therefore, skin grafting was performed as planned and yielded a favorable response. After rehabilitation, the patient could walk without support and infection did not recur. However, he had severe liver cirrhosis and large esophageal varices, and he eventually died from sudden varix rupture. Necrotizing fasciitis is an uncommon soft tissue infection, associated with high morbidity and mortality, and early recognition and treatment are crucial for survival. Acinetobacter is rarely associated with necrotizing fasciitis. Although this is a very rare case of the occurrence of necrotizing fasciitis due to A. calcoaceticus infection, we believe that this organism can be pathogenic in immunocompromised patients such as those with liver cirrhosis by reporting this case.
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan. Electronic address: enjoyjoying@gmail.com.
authors: Yuko
authors: Y
authors: Nonaka
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan.
authors: Masaaki
authors: M
authors: Nagae
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan.
authors: Takahito
authors: T
authors: Omae
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan.
authors: Shuhei
authors: S
authors: Yamamoto
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan.
authors: Ryosuke
authors: R
authors: Horitani
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan.
authors: Daigen
authors: D
authors: Maeda
authors: Department of Emergency and General Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1 Higashidaimotsu-cho, 1chome Amagasaki-shi, Hyogo 660-0828, Japan.
authors: Takayuki
authors: T
authors: Yoshinaga
mesh_terms: D000151:Acinetobacter Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016954:Acinetobacter calcoaceticus / Q000302:isolation & purification*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Acinetobacter infections; Community-acquired infections; Necrotizing fasciitis