Sore throat & fever – don't miss out on a rare disease

Introduction:

With an incidence of 0,4 – 1/100000 inhabitants and a high mortality, the necrotizing fasciitis (NF) is a rare disease and requires a fast and intensive management. The NF is classified in four different types, depending on their microbiologic spectrum. The LRINEC is used to detect the presence of a NF by assessing the total white cell count, hemoglobin, sodium, glucose, serum creatinine and C-reactive protein. A NF is probable for patients with a LRINEC score > 6. NF was diagnosed in 4 patients (3♂, 1♀, at age of 21 – 74). We are presenting the cause, clinical development and outcome of the 4 patients under consideration of their LRINEC and imaging reports.

Material and methods:

On admission, patients 1 – 3 reached a LRINEC > 6, patient 4 < 6. Gas formation was present in patient 2 – 4. Predisposing factor of patient 1 was cannabis abuse, type 1 diabetes and a poor general state of health, patient 3 had a renal cell carcinoma, patient 4 a bronchial carcinoma. Patient 1 and 2 had a tonsillitis, patient 3 a panendoscopic examination shortly before. Patient 4 had a superinfected neck metastasis. All patients were treated with fasciotomy, wound debridement and multiple antibiosis. Patient 1 and 4 had a type 4 (candida) NF, Patient 3 a type 1 (proteus and fusobacteria) and patient 2 a type 2 (streptococcus and staph. aureus) NF. Patient 1 died of an acute ventilation incident, patient 4 of the underlying disease. Patient 2 and 3 survived.

Conclusion:

The LRINEC as well as gas formation in imaging reports in all patients led to the direct diagnosis of NF. Therefore we recommend the use of these two indicators when diagnosing severe neck infection.

Publication History

Publication Date:
23 May 2018 (online)