Community-acquired necrotizing fasciitis due to Pseudomonas aeruginosa

Excerpt

Sir: A 49-year-old man presented with dyspnoea, peripheral oedema and coldness for which he had daily taken a bath during the previous few weeks. He admitted excessive alcohol use and concomitant poor dietary intake. He had lost 7 kg of weight in the past month. Body temperature was 35.9°C, blood pressure 80/60 mmHg and heart rate 100/min. Physical examination revealed jaundice, hepatomegaly, cyanotic cold extremities, peripheral oedema and petechiae. The left leg showed multiple bullae and diffuse erythematous-to-violaceous colouring of the skin (Fig. 1). Both clinical and laboratory examinations were compatible with septic shock and multiple organ failure, including respiratory, circulatory, renal and hepatic failure and diffuse intravascular coagulation. Treatment consisted of volume resuscitation, inotropic support, mechanical ventilation, corticosteroids, haemofiltration and antibiotics. The next day, blood cultures and a biopsy of the left leg revealed Pseudomonas aeruginosa. Histopathological examination showed necrosis of the skin and subcutis including the fascia. Fasciotomy of the left leg was performed to prevent compartment syndrome. Since the necrotic skin of the left leg was judged to be the source of the ongoing sepsis, extensive degloving was performed. However, the clinical condition deteriorated and the patient died. Using a pulsed-field gel electrophoresis technique, cultures of shower water from the patient's bathroom at home revealed a P. aeruginosa strain with identical DNA typing as the one cultured in our patient.

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