Rectum Perforation Complicated Necrotizing Fasciitis Present As Lumbar Disc Herniation: Case Report

Overview

Journal J Acute Med

Date 2025 Mar 10

PMID 40061307

Authors

Thian-Hwang Ho

Sai-Wai Ho

Affiliations

Soon will be listed here.

Abstract

Necrotizing fasciitis (NF) is an infection of the deep soft tissues that results in progressive destruction of the muscle fascia and overlying subcutaneous fat. These infections can be sudden, vicious, and fast-spreading. If not treated quickly with antibiotics and debridement of the infected tissue, the patient may develop septic shock, which may lead to multiple organ failure and death. NF is difficult to early diagnose due to the overlying tissue can appear unaffected initially. We report an unusual case of NF of the buttock and left thigh that clinically mimics lumbar disc herniation. This patient was successfully treated with emergent fasciotomy and intensive care. We recommend that patients with low back pain and unilateral leg pain should be diagnosed carefully especially keeping NF in differential diagnosis.

References

Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F . Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg. 2012; 72(3):560-6. DOI: 10.1097/TA.0b013e318232a6b3. View

Kim K, Kim Y, Lee C, Kang J, Kim Y . Magnetic resonance imaging in the evaluation of the lumbar herniated intervertebral disc. Int Orthop. 1993; 17(4):241-4. DOI: 10.1007/BF00194188. View

Darenberg J, Luca-Harari B, Jasir A, Sandgren A, Pettersson H, Schalen C . Molecular and clinical characteristics of invasive group A streptococcal infection in Sweden. Clin Infect Dis. 2007; 45(4):450-8. DOI: 10.1086/519936. View

Goh T, Goh L, Ang C, Wong C . Early diagnosis of necrotizing fasciitis. Br J Surg. 2013; 101(1):e119-25. DOI: 10.1002/bjs.9371. View

Zhang A, Xu A, Ansari K, Hardacker K, Anderson G, Alsoof D . Lumbar Disc Herniation: Diagnosis and Management. Am J Med. 2023; 136(7):645-651. DOI: 10.1016/j.amjmed.2023.03.024. View

Shimizu T, Tokuda Y . Necrotizing fasciitis. Intern Med. 2010; 49(12):1051-7. DOI: 10.2169/internalmedicine.49.2964. View

Bruun T, Rath E, Madsen M, Oppegaard O, Nekludov M, Arnell P . Risk Factors and Predictors of Mortality in Streptococcal Necrotizing Soft-tissue Infections: A Multicenter Prospective Study. Clin Infect Dis. 2020; 72(2):293-300. PMC: 7840107. DOI: 10.1093/cid/ciaa027. View

Kaul R, McGeer A, Low D, Green K, Schwartz B . Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med. 1997; 103(1):18-24. DOI: 10.1016/s0002-9343(97)00160-5. View

Ekedahl H, Jonsson B, Annertz M, Frobell R . Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms. Arch Phys Med Rehabil. 2017; 99(4):726-735. DOI: 10.1016/j.apmr.2017.11.006. View

10.

Wong C, Chang H, Pasupathy S, Khin L, Tan J, Low C . Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003; 85(8):1454-60. View

11.

Salati S . Necrotizing fasciitis a review. Pol Przegl Chir. 2023; 95(2):1-8. DOI: 10.5604/01.3001.0015.7676. View

12.

Leiblein M, Marzi I, Sander A, Barker J, Ebert F, Frank J . Necrotizing fasciitis: treatment concepts and clinical results. Eur J Trauma Emerg Surg. 2017; 44(2):279-290. DOI: 10.1007/s00068-017-0792-8. View

13.

Stevens D, Tanner M, Winship J, Swarts R, Ries K, Schlievert P . Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989; 321(1):1-7. DOI: 10.1056/NEJM198907063210101. View

14.

van der Windt D, Simons E, Riphagen I, Ammendolia C, Verhagen A, Laslett M . Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010; (2):CD007431. DOI: 10.1002/14651858.CD007431.pub2. View