NoteSalmonella group C necrotizing fasciitis: a case report and review of the literature
Introduction
Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and life-threatening infectious process primarily involving fascia and subcutaneous tissue. Most cases of NF represent a synergistic or mixed bacterial infection of aerobic and anaerobic bacteria. Group A streptococci, Staphylococcus aureus, Enterobacteriaceae and Peptostreptococcus spp. have been the most commonly identified pathogens (Wong et al., 2003). Salmonella is generally associated with a range of benign to life-threatening human infections inclusive of asymptomatic enteric carriage, gastroenteritis, enteric fever, bacteremia, and mycotic aneurysm; rarely has salmonella NF been reported (Jidpugdeebodin and Punyagupta, 2004, Leiberman et al., 1991, Sanchez et al., 1984, Simeon-Aznar et al., 1990, Sy et al., 2001). We report a case of Salmonella group C NF in a patient with systemic lupus erythematosus (SLE) who was successfully treated with cefoperazone–sulbactam in conjunction with fasciotomy and surgical debridement.
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Case report
A 35-year-old Thai woman, diagnosed with SLE 2 months earlier, presented to our hospital with a 2-day history of high-grade fever and right leg pain. She reported a history of diarrhea that began after eating a boiled egg 1 week before admission, but had no significant animal contact, travel history, leg trauma, or recall of uncooked poultry consumption. She was taking prednisolone (60 mg/day) as treatment of SLE with persistent active nephritis (membranous glomerulonephritis type V) for 2
Discussion
Focal salmonellosis represents less than 6% of all infections due to nontyphoidal Salmonella and may involve any organ system (Cohen et al., 1987, Fernandez Guerrero et al., 1997). Local suppurative complications have been recognized in 7–10% of all cases of salmonellosis in the general population (Cohen et al., 1987, Fernandez Guerrero et al., 1997). However, in immunocompromised hosts, focal infections account for 25% of systemic salmonellosis (Fernandez Guerrero et al., 1997). The most
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2009, Rheumatic Disease Clinics of North AmericaCitation Excerpt :Necrotizing fasciitis in patients who have rheumatic disease has been reported; however, it is not clear whether the incidence is higher in this patient group when compared with that of the general population.8 Several reports of necrotizing fasciitis occurring in patients who have systemic lupus erythematosus (SLE) have been reported.8,17–21 Kamran and colleagues20 found eight cases of necrotizing fasciitis in a cohort of 449 patients who had SLE followed between 1994 and 2007.
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