Ultrasound-Guided Diagnosis and Percutaneous Drainage in Subacute Necrotizing Fasciitis of the Lower Extremities: A Report of Two Cases

Necrotizing fasciitis (NF) is a life-threatening disease that is diagnosed through an exploratory incision and typically requires surgical debridement. Reports of non-surgical cures are limited to specific cases, such as NF affecting only the head and neck regions. The two patients (a woman and a man) were both in their 70s and underwent maintenance dialysis for diabetic nephropathy. Both presented with leg pain. Samples were obtained using ultrasound-guided aspiration, and NF was diagnosed based on the characteristics (dishwater-like gray exudate) of the samples and the presence of gram-positive cocci (the culture results identified ). Although an initial treatment with antimicrobial agents was administered, no improvement was observed. Percutaneous drainage was then performed, which led to successful outcomes in both cases. In addition to the clinical course, blood tests, and imaging studies, ultrasound-guided needle aspiration can aid in the accurate diagnosis of NF. Percutaneous drainage may be a minimally invasive alternative to surgical debridement for subacute NF. Nonetheless, careful consideration should be given to the indications for percutaneous drainage.