Handchir Mikrochir Plast Chir 2022; 54(02): 155-159
DOI: 10.1055/a-1712-4166
Fallbericht

Letaler Verlauf einer fulminanten nekrotisierenden Fasziitis und Clostridium-perfringens-Infektion nach Resektion eines Weichteil-Sarkoms

Fatal necrotizing fasciitis with clostridium perfringens infection following resection of soft tissue sarcoma of the thigh
1   BG-Universitätsklinikum Bergmannsheil Bochum; Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum
,
Maria Bernstorff
2   Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Chirurgische Universitätsklinik und Poliklinik
,
Marcus Lehnhardt
1   BG-Universitätsklinikum Bergmannsheil Bochum; Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum
,
Björn Behr
1   BG-Universitätsklinikum Bergmannsheil Bochum; Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum
,
Johannes Maximilian Wagner
1   BG-Universitätsklinikum Bergmannsheil Bochum; Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum
› Author Affiliations

Zusammenfassung

Vorgestellt wird der Fall eines 57-jährigen Patienten mit letalem Verlauf nach Resektion eines Myxofibrosarkoms am Oberschenkel. Auf dem Boden einer nekrotisierenden Fasziitis bei Mischinfektion von Staphylococcus lugdunensis und Clostridium perfringens mit Ausbildung ausgedehnter Myonekrosen kam es zu einem septischen Schock mit Hämolyse und Multiorganversagen. Die Autoren zeichnen den fulminanten Verlauf dieser sehr seltenen Komplikation nach onkologischer Resektion nach und diskutieren das chirurgische Vorgehen anhand aktueller Literatur.

Abstract

We present the case of a 57-year-old male patient with a fatal outcome after resection of a soft tissue sarcoma of the lateral thigh. A polymicrobial surgical site infection with Staphylococcus lugdunensis and Clostridium perfringens caused fulminant necrotising fasciitis with an additional gas gangrene. The patient suffered a severe sepsis with consecutive haemolysis and multiorgan failure. The authors recapitulate the deadly progress of a rarely reported complication after oncological resection. The therapeutic approach and surgical interventions are discussed based on the current literature.



Publication History

Received: 20 August 2021

Accepted: 15 November 2021

Article published online:
13 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 von Glinski M, Dadras M, Wallner C. et al. Necrotizing Fasciitis. Handchir Mikrochir Plast Chir 2021; 53: 312-319
  • 2 Lancerotto L, Tocco I, Salmaso R. et al. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg 2012; 72: 560-566
  • 3 Abu El Hawa AA, Dekker PK, Mishu MD. et al. Early Diagnosis and Surgical Management of Necrotizing Fasciitis of the Lower Extremities: Risk Factors for Mortality and Amputation. Advances in wound care. 2021
  • 4 Adelson MD, Miranda FR, Strumpf KB. Necrotizing fasciitis: A complication of squamous cell carcinoma of the vulva. Gynecologic Oncology 1991; 42: 98-102
  • 5 Karam C, Kozman MA, Fewtrell M. et al. Perforated descending colon adenocarcinoma manifesting as necrotizing fasciitis. ANZ journal of surgery 2020; 90: e100-e102
  • 6 Rakusic Z, Krpan AM, Sjekavica I. Fulminant Fournier‘s gangrene in a patient with gastric cancer treated with ramucirumab and paclitaxel. Therapeutic advances in drug safety 2020; 11: 2042098620946556
  • 7 Ichisawa A, Jin H, Hagiwara Y. et al. Successful Treatment of Necrotizing Fasciitis Due to Ascending Colon Cancer-A Case Report. Gan to kagaku ryoho Cancer & chemotherapy 2019; 46: 2574-2576
  • 8 Bahary CM, Joel-Cohen SJ, Neri A. Necrotizing fasciitis. Obstetrics and gynecology 1977; 50: 633-637
  • 9 Gesakis K, Tanos G, Onyekwelu O. et al. Primary spindle cell sarcoma of the breast masquerading as necrotizing fasciitis. J Surg Case Rep 2014; 2014: rjt096
  • 10 Korambayil SM, Iyer S, Williams DJ. Emergency hip disarticulations for severe necrotising fasciitis of the lower limb: a series of rare cases from a rural district general hospital. Annals of the Royal College of Surgeons of England 2021; 103: e223-e226
  • 11 Zalavras CG, Rigopoulos N, Ahlmann E. et al. Hip disarticulation for severe lower extremity infections. Clin Orthop Relat Res 2009; 467: 1721-1726
  • 12 van Bunderen CC, Bomers MK, Wesdorp E. et al. Clostridium perfringens septicaemia with massive intravascular haemolysis: a case report and review of the literature. The Netherlands journal of medicine 2010; 68: 343-346
  • 13 Shindo Y, Dobashi Y, Sakai T. et al. Epidemiological and pathobiological profiles of Clostridium perfringens infections: review of consecutive series of 33 cases over a 13-year period. Int J Clin Exp Pathol 2015; 8: 569-577
  • 14 Shetty P, Deans R, Abbott J. A case of Clostridium perfringens infection in uterine sarcoma. The Australian & New Zealand journal of obstetrics & gynaecology 2010; 50: 495-496
  • 15 Kao MJ, Roy M, Harter J. et al. Uterine Sarcoma Presenting with Sepsis from Clostridium perfringens Endometritis in a Postmenopausal Woman. Case reports in obstetrics and gynecology 2018; 2018: 8217296
  • 16 Wong CH, Chang HC, Pasupathy S. et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003; 85: 1454-1460
  • 17 Dadras M, Koepp P, Wagner JM. et al. Antibiotic prophylaxis for prevention of wound infections after soft tissue sarcoma resection: A retrospective cohort study. J Surg Oncol 2020; 122: 1685-1692
  • 18 Müller D, Kaiser D, Sairanen K. et al. Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology – A Narrative Review of Current Concepts. Journal of bone and joint infection 2019; 4: 254-263
  • 19 Stahl D, Gentles AJ, Thiele R. et al. Prognostic profiling of the immune cell microenvironment in Ewing´s Sarcoma Family of Tumors. OncoImmunology 2019; 8: e1674113
  • 20 Baxevanis CN, Perez SA. Cancer Dormancy: A Regulatory Role for Endogenous Immunity in Establishing and Maintaining the Tumor Dormant State. Vaccines 2015; 3: 597-619
  • 21 Wilky BA, Goldberg JM. From vision to reality: deploying the immune system for treatment of sarcoma. Discovery medicine 2017; 23: 61-74