Question

A ~55 year-old female with a history of ESRD and diabetes who presented to the ED with progressively worsening foot odor. An x-ray was performed. The picture below shows the right foot.

What is the diagnosis?

 

 

 

 

 

Answer

Necrotizing infection of the foot

• Labs will show increased lactate, increased CK, increased WBC, and decreased sodium
  • Admission serum lactate (>6mmol/L) and sodium levels (<135mEq/L) are predictors of mortality
• On x-ray, the characteristic finding of gas in the soft tissues is seen in only a minority of cases.
• The presence of gas in the facial planes is highly specific, but not very sensitive.
• Diagnosis of necrotizing fasciitis or myonecrosis can only be established by surgical exploration.
• Treatment includes a Carbapenem or Zosyn plus Clindamycin and Vancomycin.

 

References

https://radiopaedia.org/articles/necrotising-fasciitis

Yaghoubian et al. Use of admission serum lactate and sodium levels to predict mortality in necrotizing soft-tissue infections. Archives of surgery. 2007.

Anaya DA and Dellinger EP.  Necrotizing soft-tissue infection: diagnosis and management. Clinical infectious diseases. 2007.