Community-Acquired Monomicrobial Pseudomonas aeruginosa Necrotizing Fasciitis: A Case Report
Taweegrit Siripongboonsitti MD, MSc1
Affiliation : 1 Department of Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
Background : Community-acquired monomicrobial Pseudomonas necrotizing fasciitis [NF] is a rare and unclassified type of
NF. Late recognition and using non-antipseudomonal antibiotics may lead to poor outcomes. This report describes the
clinical features and management of Pseudomonas aeruginosa NF in a cancer patient.
Case Report : A 68-year-old Thai man with poorly controlled diabetes and advanced lung cancer, who was taking docetaxel for
12 days, was admitted to Chulabhorn Cancer Center. His medical history suggested a prior minor injury to his left thigh. He
presented with fever and an erythematous lesion in his left thigh and developed changes in consciousness and respiratory
failure. Clinical features showed septic shock with diabetic ketoacidosis [DKA], a hyperosmolar hyperglycemic state
[HHS], multiple foci of ecthyma gangrenosum, and soft tissue infection. He was then empirically treated with meropenem,
had resuscitation of hemodynamics, and DKA/HHS corrected. Central necrosis later developed with blebs on his left thigh.
NF was diagnosed and necrotic tissue resection was immediately performed. P. aeruginosa was isolated from hemocultures
and tissue culture. A 2-week course of antibiotics with adequate tissue debridement improved clinical and microbiological
outcomes.
Conclusion : A case of monomicrobial P. aeruginosa NF was diagnosed after minor trauma in a severely immunocompromised
host. The patient’s excellent outcome was achieved by a high index of suspicion by physicians in host factors, prompt
diagnosis, early anti-pseudomonal antibiotic treatment, good hemodynamic resuscitation, immune reversal therapy, and
immediate surgical debridement.
Keywords : Pseudomonas necrotizing fasciitis, Soft tissue infection, Hemodynamics, P. aeruginosa, Immunocompromised host
