Journal de néphrologie et thérapeutique

Necrotizing Fasciitis in a Patient with Minimal Change Disease

Abstract

Jyun-Jie Cai,Chia-Chu Chang,Chirn-Bin Chang*

Nephrotic syndrome complicated by necrotizing fasciitis is rare. Necrotizing fasciitis is a skin and soft tissue infection with a rapid progression and difficult diagnosis. Moreover, the early presentation of necrotizing fasciitis is similar to that of cellulitis. Serratia marcescens is a rare pathogenic cause of necrotizing fasciitis, even in skin and soft tissue infection. We present a patient with nephrotic syndrome complicated by necrotizing fasciitis caused by Serratia marcescens. A 49-year-old Chinese woman presented with minimal change disease and nephritic syndrome. She was admitted for pain in her right leg, for which she received cefazolin and clindamycin. However, 3 days later, a sanguineous bulla developed over her left calf, and she developed septic shock. After an emergency fasciotomy and broad-spectrum antibiotic administration, this patient died 12 h after fasciotomy. The blood culture and deep tissue culture collected during surgery both yielded Serratia marcescens. This unusual case reminds physicians that gramnegative bacilli can be pathogenic in soft tissue, especially in immunocompromised patients.