Document Type : Case reports

Authors

• Jun-Li Tsai ¹
• Shang-Feng Tsai ²

¹ Department of family medicine, Cheng Ching General Hospital, Taichung, Taiwan

² Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, China Medical University, Taichung, Taiwan Department of Life Science, Tunghai University, Taichung, Taiwan

Abstract

Introduction: Necrotizing fasciitis is not rare in clinical practice, but a Klebsiella pneumoniae-related is rare, especially in patients undergoing hemodialysis. Many patients with necrotizing fasciitis have a miserable outcome even though they receive amputation. Case Presentation: A 76-year-old male was initially admitted to the center due to suspected cellulitis in Taichung, Taiwan. However, the treatment response was beyond expectation, and a plain film X-ray was performed on his leg. To our surprise, it showed ap- parent gas and calciphylaxis. Easy examination detected the severe disease. Immediate surgical debridement was performed, and his legs and life were successfully saved, although the outcomes of the disease were miserable. The tissue culture yielded Klebsiella pneumoniae. This pathogen, related to necrotizing fasciitis, is rare in the currently published articles. The possible risk factors were the endemic region, diabetes mellitus, calciphylaxis, old age, frequent iron supplements, and repeated tissue hypoperfusion during hemodialysis.
Conclusion: In conclusion, meticulously and timely diagnosed necrotizing fasciitis in high-risk groups is the most important factor to ensure a positive patient outcome.

Keywords

• Calciphylaxis
• Cellulitis
• Fasciitis
• Hemodialysis
• Klebsiella pneumoniae
• Necrotizing