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Case Reports in Medicine
Volume 2012 (2012), Article ID 253906, 4 pages
http://dx.doi.org/10.1155/2012/253906
Case Report

Necrotizing Fasciitis: Diagnostic Challenges in a Mute Bedridden Patient with Atypical Laboratory Parameters

1Department of Public Health, Fairview Developmental Center, Costa Mesa, CA 92626, USA
2Fairview Developmental Center, Costa Mesa, CA 92626, USA
3School of Medicine, St. George’s University, Grenada
4Royal Medical Group, 1120 W. Warner Avenue, Santa Ana, CA 92707, USA

Received 21 August 2012; Accepted 11 October 2012

Academic Editor: Jeffrey M. Weinberg

Copyright © 2012 Ghan-Shyam Lohiya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient’s right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever ( ), and leukocytosis (count: ; was ten days earlier). Necrotizing fasciitis (NF) was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.