Anesth Pain Med.  2018 Jul;13(3):298-301. 10.17085/apm.2018.13.3.298.

Necrotizing fasciitis likely mistaken for chronic low back pain: A case report

• Yun SH
• Park JC
• Kim YJ

• KMID: 2436038
• DOI: http://doi.org/10.17085/apm.2018.13.3.298

Abstract

Necrotizing fasciitis is a significant factor of morbidity and mortality due to its sudden onset and rapid spread. It is accompanied by systemic toxicity and often fatal unless promptly recognized and aggressively treated. We reported a patient who presented symptoms confused with disc herniation and delayed initial diagnosis. The patient was treated for chronic low back pain. The origin of the pain was a foreign body-induced intra-abdominal infection that invaded the back muscles and eventually progressed to necrotizing fasciitis.

Keyword

Intervertebral disc displacement; Intraabdominal infections; Low back pain; Necrotizing fasciitis

MeSH Terms

Back Muscles
Diagnosis
Fasciitis, Necrotizing*
Humans
Intervertebral Disc Displacement
Intraabdominal Infections
Low Back Pain*
Mortality

Figure

• 

  Fig. 1 Lumbar spine magnetic resonance imaging showing central to left paracentral disc protrusion at L4–5 with annular tear disc bulge at L3–4 and L2–3. In addition, there is soft-tissue intensity in the right pre-iliac lesion measuring 10.0 × 3.0 × 5.0 cm suggesting a parailiac phlegmon involving the right iliacus muscle.

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  Fig. 2 Precontrast computed tomography showing soft-tissue lesion (10.5 cm) in the right posterior pararenal space, psoas muscle, iliacus muscle, and right posterior abdominal wall. A linear high-density lesion is seen adjacent to the terminal ileum.

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  Fig. 3 Intraoperative finding for a foreign body ruled out a fish bone.

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