ABSTRACT
Necrotizing soft tissue infections (NSTI) can be rapidly progressive and polymicrobial
in etiology. Establishing the element of necrotizing infection poses a clinical challenge.
A 64-year-old diabetic patient presented to our hospital with a gangrenous patch on
anterior abdominal wall, which progressed to an extensive necrotizing lesion within
1 week. Successive laboratory risk indicator for necrotizing softtissue infections
(LRINEC) scores confirmed the necrotizing element. Cultures yielded Enterococci, Acinetobacter
species and Apophysomyces elegans and the latter being considered as an emerging agent of Zygomycosis in immunocompromised
hosts. Patient was managed with antibiotics, antifungal treatment and surgical debridement
despite which he succumbed to the infection. NSTI’s require an early and aggressive
management and LRINEC score can be applied to establish the element of necrotizing
pathology. Isolation of multiple organisms becomes confusing to establish the etiological
role. Apophysomyces elegans, which was isolated in our patient is being increasingly reported in cases of necrotizing
infections and may be responsible for high morbidity and mortality. This scoring has
been proposed as an adjunct tool to Microbiological diagnosis when NSTI’s need to
be diagnosed early and managed promptly to decrease mortality and morbidity, which
however may not come in handy in an immunocompromised host with polymicrobial aggressive
infection.
Key words:
Laboratory risk indicator for necrotizing soft tissue infections score - necrotizing
infection - zygomycosis
