title: Missed acute appendicitis presenting as necrotising fasciitis of the thigh.
abstract: Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a 26-year-old woman who presented with severe thigh pain and swelling associated with irritability of a few hours' duration following 2 days history of right abdominal pain. Urgent MRI and CT scan showed features of necrotising fasciitis in the thigh spreading from an inflamed appendix. Emergency surgery was performed which revealed perforated appendix with disseminated infection in the intraperitoneal and retroperitoneal spaces as well as the right thigh. The patient rapidly deteriorated with evidence of sepsis, shock and renal impairment. In spite of surgery and all supportive measures, she succumbed shortly postoperatively. Blood culture revealed Staphylococcus aureus and Streptococci, while tissue culture showed growth of Escherichia coli and proteus.
authors.affiliation: Department of Radiology, Khoula Hospital, Muscat, Oman.
authors.forename: Sawsan
authors.initials: S
authors.lastname: Taif
authors.forename: Asif
authors.initials: A
authors.lastname: Alrawi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003646:Debridement; D057210:Delayed Diagnosis; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011512:Proteus Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013848:Thigh / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents