title: Necrotizing fasciitis--a diagnostic dilemma: two case reports.
abstract: BACKGROUND
  Necrotizing soft tissue infections can affect various tissue planes. Although predisposing etiologies are many, they mostly center on impaired immunity occurring directly or indirectly and loss of integrity of protective barriers which predispose to infection. The nonspecific presentation may delay diagnosis and favor high mortality.
  
  
  METHODS
  Two case vignettes are presented. The first patient, a 44-year-old healthy South Asian man with a history of repeated minor traumatic injury presented to a primary health care center with a swollen left lower limb. He was treated with antibiotics with an initial diagnosis of cellulitis. Because he deteriorated rapidly and additionally developed intestinal obstruction, he was transferred to our hospital which is a tertiary health care center for further evaluation and management. Prompt clinical diagnosis of necrotizing soft tissue infection was made and confirmed on magnetic resonance imaging as necrotizing fasciitis. Urgent debridement was done, but the already spread infection resulted in rapid clinical deterioration with resultant mortality. The second patient was a 35-year-old South Asian woman with systemic lupus erythematous receiving immunosuppressive therapy who developed left lower limb pain and fever. Medical attention was sought late as she came to the hospital after 4 days. Her condition deteriorated rapidly as she developed septic shock and died within 2 days.
  
  
  CONCLUSIONS
  Necrotizing fasciitis can be fatal when not recognized and without early intervention. Clinicians and surgeons alike should have a greater level of suspicion and appreciation for this uncommon yet lethal infection.
authors: National Hospital of Sri Lanka, Regent Street, Colombo 10, Sri Lanka. rayno.navinan@gmail.com.
authors: Mitrakrishnan Rayno
authors: MR
authors: Navinan
authors: Jevon
authors: J
authors: Yudhishdran
authors: Thambyaiah
authors: T
authors: Kandeepan
authors: Aruna
authors: A
authors: Kulatunga
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis*; D003646:Debridement; D018450:Disease Progression; D042241:Early Diagnosis; D061345:Early Medical Intervention; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D018805:Sepsis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents