Document Type : Case Report

Authors

1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences,Isfahan, Iran

3 Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran,Iran

Abstract

BACKGROUND: Necrotizing fasciitis is a life-threatening soft tissue infection characterized by rapid tissue necrosis, often leading to sepsis and multisystem organ failure. Necrotizing fasciitis can rarely occur as a post-procedural complication, particularly following cardiac catheterization or angiography. This case report presents the clinical presentation and management of a 64-year-old female with a history of chronic endocarditis and valvular involvement who developed necrotizing fasciitis after femoral coronary angiography.
Case Presentation: A 64-year-old female with a history of chronic endocarditis and valvular involvement underwent femoral coronary angiography as part of her cardiac evaluation. On the first postoperative day, the patient developed worsening pain, swelling, and redness in her right lower extremity, which worsened despite antibiotic therapy and pain management. The patient was diagnosed with necrotizing fasciitis. An emergent right lower extremity fasciotomy was performed to debride the necrotic tissue and release the tension caused by acute compartment syndrome.
CONCLUSION: This case underscores the importance of maintaining a high index of suspicion for NF in patients with persistent soft tissue infection symptoms post-procedure. Early recognition, prompt diagnosis, and aggressive surgical intervention are crucial for the successful management of post-procedural NF following femoral coronary angiography. This report emphasizes the need for a multidisciplinary approach and vigilance in caring for patients to ensure optimal outcomes in such rare but severe complications.

Keywords

1. Agarwal L, Yasin A. Necrotising fasciitis: a fatal case of sepsis and a diagnostic challenge - case report and review of literature. Int J Emerg Med. 2018 Apr 6;11(1):23. https://doi.org/10.1186/s12245-018-0183-x
2. Dapunt U, Klingmann A, Schmidmaier G, Moghaddam A. Necrotising fasciitis. BMJ Case Rep. 2013 Dec 10;2013:bcr2013201906. https://doi.org/10.1136/bcr-2013-201906
3. Leiblein M, Marzi I, Sander AL, Barker JH, Ebert F, Frank J. Necrotizing fasciitis: treatment concepts and clinical results. Eur J Trauma Emerg Surg. 2018 Apr;44(2):279-90. https://doi.org/10.1007/s00068-017-0792-8
4. van Son K, Savelkoul C, Mollen R, Tjan DH. A case of fulminant necrotising fasciitis. BMJ Case Rep. 2017 Apr 29;2017:bcr2016219142. https://doi.org/10.1136/bcr-2016-219142
5. Taviloglu K, Cabioglu N, Cagatay A, Yanar H, Ertekin C, Baspinar I, et al. Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg. 2005 Apr;71(4):315-20.
6. Miller AT, Saadai P, Greenstein A, Divino CM. Postprocedural necrotizing fasciitis: a 10-year retrospective review. Am Surg. 2008 May;74(5):405-9.
7. Hasham S, Matteucci P, Stanley PR, Hart NB. Necrotising fasciitis. BMJ. 2005 Apr 9;330(7495):830-3. https://doi.org/10.1136/bmj.330.7495.830
8. Tsai MH, Leu JG, Fang YW, Hsieh SC. Necrotizing fasciitis and infective endocarditis caused by Escherichia coli in a hemodialysis patient. Hemodial Int. 2015 Oct;19(4):E41-4. https://doi.org/10.1111/hdi.12264
9. Sergi C, Weitz J, Hofmann WJ, Sinn P, Eckart A, Otto G, Schnabel PA, Otto HF. Aspergillus endocarditis, myocarditis and pericarditis complicating necrotizing fasciitis. Case report and subject review. Virchows Arch. 1996 Oct;429(2-3):177-80. https://doi.org/10.1007/bf00192441