PP 44. Necrotising Fasciitis; the Difficulties of Diagnosis in the ICU Setting

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H. Creasy, Z. Jessop, A Woollard, A Mosahebi

19:28 - 19:34h at Margrit Room

Categories: Abdominal Wall and Hernia, Plastic and Reconstructive Surgery, Poster Session

Session: Poster (P3) - Abdominal Wall & Hernia / Plastic & Reconstructive Surgery

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Background
Necrotising fasciitis is a rare, rapidly progressive infection characterised by widespread necrosis of subcutaneous tissue and fascia. The high mortality associated with the infection mandates early recognition and prompt surgical intervention.

Material and Methods
We describe the case of a 30-year-old female who initially presented with epistaxis and a painful right wrist. She had a complex medical history which included renal failure secondary to lupus nephritis, coronary bypass and mitral valve replacement. Over the course of her admission she deteriorated and was transferred to the Intensive Care Unit (ICU) following a cardiac arrest. While intubated she developed necrotising fasciitis, however there was a significant delay in diagnosis and subsequent surgical debridement.

Result
A total of 22 hours passed from her spiking a temperature, and exhibiting cardiovascular instability requiring inotropic support, to surgical debridement. We reflect on the timing of recognition of the source of sepsis and the non-specific early clinical findings associated with the infection. We examine the effect that the intensive care environment had on the detection of these early indicators, notably her altered state of consciousness and concurrent multi-organ support.

Conclusion
While the ICU has a prominent role in the management of patients with necrotising fasciitis, this case highlights the difficultly of establishing a diagnosis when it presents in a patient already requiring intensive care. We propose that the skin should be considered as a source when performing a septic screen and that intensivists should have a high index of suspicion due to paucity of specific cutaneous findings.