title: Fournier's gangrene (necrotising fasciitis) complicated by renal and respiratory insufficiency: a case report.
abstract: A case report of a 68-year-old male obese diabetic patient with an abscess of left femoral region, and diffuse inflammation of abdominal wall and genital region developing sepsis, respiratory and renal failure. At admission in the regional hospital a diagnosis of polymicrobial necrotising fasciitis with suspected sepsis was declared. The patient was transferred to the special intensive care unit (SICU) of Burns and reconstructive surgery at the Kosice-Saca. The patient was treated surgically, with hyperbaric oxygen and pharmacologically to control his diabetes. The main aetiological agent of the condition was identified as Stenotrophomonas maltophilia. In addition to respiratory and metabolic acidosis and gastric bleeding occurred. Due to acute renal failure (day 38) the patient was transferred to clinic of anaesthesiology and the intensive care medicine at the University Hospital in Kosice. The patient was treated by continuous veno-venous haemodialysis, mechanical ventilation and nasogastric nutritional support. On day 48 the conscious sub-febrile patient with healed wounds was transferred back to the regional hospital with ventilation support and continuous renal replacement therapy. His diabetes was uncontrolled, and only kidney parameters remained pathological. The survival of this patient with an extremely poor prognosis was achieved through prompt transfer to a specialised centre, early identification of the aetiological agent and immediate appropriate antibiotic treatment as a result of good cooperation between surgeons and laboratory specialists.
authors.affiliation: Clinic of Burns and Reconstructive Surgery, 1st Private Hospital, Kosice-Saca, Slovakia.
authors.forename: E
authors.initials: E
authors.lastname: Frisman
authors.affiliation: Institute of Pathological Physiology, Medical Faculty, Safarik University, Kosice, Slovakia.|Institute of Nanobiomedicine and Regenerative Medicine, Faculty of Healthcare, Miskolc University, Miskolc Hungary.
authors.forename: O
authors.initials: O
authors.lastname: Rácz
authors.affiliation: Clinic of Burns and Reconstructive Surgery, 1st Private Hospital, Kosice-Saca, Slovakia.
authors.forename: J
authors.initials: J
authors.lastname: Beck
authors.affiliation: Clinic of Anesthesiology and Intensive Care Medicine, Medical Faculty, Safarik University, Kosice, Slovakia.
authors.forename: J
authors.initials: J
authors.lastname: Firment
authors.affiliation: Clinic of Burns and Reconstructive Surgery, 1st Private Hospital, Kosice-Saca, Slovakia.
authors.forename: L
authors.initials: L
authors.lastname: Bodnárová
mesh_terms: D000368:Aged; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000628:therapy; D018934:Fournier Gangrene / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
keywords: Necrotising fasciitis; diabetes mellitus; renal failure; respiratory insufficiency