Necrotizing Fasciitis

Necrotizing Fasciitis

EMKF

Necrotizing Fasciitis

KEY POINTS

  • Necrotizing fasciitis may be misdiagnosed as cellulitis due to the benign appearance of cutaneous findings early in the clinical course.
  • Clues to the diagnosis of necrotizing fasciitis are vital sign abnormalities, swelling, and severe pain out of proportion to cutaneous findings.
  • If you are suspicious for necrotizing fasciitis, have a low threshold to start broad-spectrum antibiotics and consult Surgery without delaying for advanced imaging, even if clinical score and plain films are unremarkable.

Necrotizing Fasciitis

EMKF

Patients classically present with the triad of pain, swelling and erythema. The most consistent feature of early NF is that the pain is out of proportion to the swelling or erythema. Other important features that make NF likely are:

  • Tenderness extending beyond the apparent involved area
  • Indistinct margins of involvement
  • Absence of lymphangitis  (because the infection is in the deep fascia and not in the skin)
  • Rapidly progressive despite the use of antibiotics
  • If the patients looks too sick for cellulitis
  • Bleb/Bullae, Crepitus (Though you cannot not rule out NF in their absence)