Abdominal necrotizing fasciitis causing acute myocardial infarction
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Necrotizing fasciitis (NF) is a surgical emergency characterized by a fulminant course and high mortality rate.1,2 NF is a severe form of soft-tissue infection.
When NF is complicated with acute myocardial infarction (AMI), acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI), the patient's chance of survival are diminished significantly.3,4 We present a case of NF of the abdominal wall with acute non-ST segment elevated myocardial infarction (NSTEMI).
No such case has previously been reported according to our review of the literature.
Case: A 52-year-old female with a known case of hypothyroidism presented to the emergency department with severe abdominal pain for two days.
She gave the history of abdominal hernia repair ten days back.
She had sinus tachycardia but other vitals were normal, with no fever or leucocytosis.
Computed Tomography (CT) of the abdomen showed anterior abdominal wall collections.
Septic workup was done, cefuroxime and metronidazole were started.
Her abdominal wall collection was drained under image guidance.
After a few hours, her blood pressure dropped and was not responding to fluid challenges so a noradrenaline infusion was started and she was transferred to the surgical intensive care unit (SICU).
Her blood work showed lactic acidosis.
Her abdomen was tender all over with swelling and induration of the abdominal wall.
Antibiotics were changed to meropenem and clindamycin to broaden the spectrum in view of the septic shock and she was immediately taken for exploratory laparotomy.
The operative findings were suggestive of necrotizing fasciitis of the anterior abdominal wall and a bold and thorough debridement was done.
She was kept intubated and ventilated for a second look and further debridement was conducted after 24 hours.
American Psychological Association (APA)
Chanda, Arshad& Shaykh, Nassar M.& Viallani, Arif& Mumtaz, Narjis& Ganaw, Adil E.& Rida, Shakeel. 2019-12-31. Abdominal necrotizing fasciitis causing acute myocardial infarction. Conference Qatar Critical Care (1st : 2019 : Doha, Qatar). . No. 2 (Special issue) (2019), pp.1-4.Doha Qatar : Hamad Medical Corporation.
Modern Language Association (MLA)
Shaykh, Nassar M.…[et al.]. Abdominal necrotizing fasciitis causing acute myocardial infarction. . Doha Qatar : Hamad Medical Corporation. 2019-12-31.
American Medical Association (AMA)
Chanda, Arshad& Shaykh, Nassar M.& Viallani, Arif& Mumtaz, Narjis& Ganaw, Adil E.& Rida, Shakeel. Abdominal necrotizing fasciitis causing acute myocardial infarction. . Conference Qatar Critical Care (1st : 2019 : Doha, Qatar).
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