Necrotizing fasciitis of lower limb: Is it ischemia or E. coli infection?

Introduction: Necrotizing fasciitis is a life-threatening soft-tissue infection characterized by a fulminant course and high mortality. Diagnosis of necrotizing fasciitis is often difficult, because nascent NF often appears deceptively benign and lack specific diagnostic clues. In addition, the manifestations of NF are similar to those of acute limb ischemia. Here, we introduce the case of necrotizing fasciitis accompanied with acute limb ischemia on left lower leg. Case Report: A 71-year-old male with a history of stomach cancer complained of vomiting and dyspnea one day before admission to our hospital. Two days after admission, his left lower extremity whitened and became edematous. Contrast-enhanced computed tomography revealed severe stenosis of the left common iliac artery. We were unable to rule out acute limb ischemia and performed endovascular revascularization. However, the leg did not improve and major amputation was performed. The leg pathology was suggestive of necrotizing fasciitis. Conclusion: We should not forget the possibility that any systemic infection can result in necrotizing fasciitis even if the patients have high risk of acute limb ischemia. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 11, November 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(11):701–705. www.ijcasereportsandimages.com Matsuo et al. 701 CASE REPORT OPEN ACCESS Necrotizing fasciitis of lower limb: Is it ischemia or E. coli infection? Takahiro Matsuo, Hiroki Mochizuki, Atsushi Mizuno, Keiichi Furukawa, Yutaro Nishi, Koichiro Niwa