Clin Orthop Surg.  2010 Dec;2(4):256-259. 10.4055/cios.2010.2.4.256.

Coagulase-Positive Staphylococcal Necrotizing Fasciitis Subsequent to Shoulder Sprain in a Healthy Woman

• Kim HJ
• Kim DH
• Ko DH

• KMID: 1719328
• DOI: http://doi.org/10.4055/cios.2010.2.4.256

Abstract

Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.

Keyword

Necrotizing fasciitis; Staphylococcus aureus; Sprain

MeSH Terms

*Arm
Coagulase/metabolism
Fasciitis, Necrotizing/*etiology/microbiology/pathology/surgery
Female
Humans
Middle Aged
Shoulder Joint/*injuries
Sprains and Strains/*complications
Staphylococcal Infections/*etiology/microbiology
Staphylococcus aureus/enzymology/isolation & purification

Figure

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  Fig. 1 A radiograph taken on the second day after trauma shows subcutaneous emphysema from the left arm to the ipsilateral shoulder, neck, and lateral chest wall.

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  Fig. 2 (A) An intraoperative photograph shows a severely swollen arm and brown-colored necrotic skin, and purulent pus discharge from the wound. (B) Another photograph shows necrosis of subcutaneous fat, fascia, infiltration of pus along the fascial plane, and necrosis and rupture of biceps and brachialis muscles. (C) The necrotic skin, subcutaneous fat, fascia, and muscles were extensively debrided.

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  Fig. 3 Histological examination of the biopsy specimen shows edematous and necrotic fascia with infiltration of polymorphonuclear cells, and underlying myonecrosis (H&E, × 40).

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