SHM Converge Scientific Abstract ePoster Gallery-Necrotizing Fasciitis of the Abdominal Wall After Paracentesis: A Case Report

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This case report describes a 64-year-old man with decompensated alcohol-related cirrhosis, hepatic encephalopathy, and prior spontaneous bacterial peritonitis who developed necrotizing fasciitis (NF) of the abdominal wall shortly after multiple paracenteses, most recently 9 days earlier. He presented from a facility with acute abdominal pain, confusion, septic shock, and exam findings concerning for severe soft tissue infection, including marked abdominal tenderness, crepitus, and purulent drainage.<br /><br />CT imaging showed subcutaneous air in the anterior abdominal wall, supporting the diagnosis of NF. He was admitted to the ICU, started on broad-spectrum antibiotics (cefepime, vancomycin, clindamycin), and treated for hepatic encephalopathy with lactulose and rifaximin. General surgery performed urgent abdominal wall debridement. Because prior blood cultures grew multidrug-resistant Klebsiella pneumoniae, antibiotics were escalated to meropenem.<br /><br />The patient improved clinically after surgery and antibiotic adjustment, with normalization of ammonia and lactate, discontinuation of vasopressors, extubation, and improved mental status.<br /><br />The report emphasizes that abdominal wall NF after paracentesis is rare but life-threatening. Cirrhosis increases susceptibility to severe infection because of immune dysfunction, and paracentesis is generally safe, making this complication unusual. Key clinical warning signs include pain out of proportion to exam, rapidly progressive erythema or edema, crepitus, and drainage. Because early NF may resemble cellulitis or abscess, diagnosis can be delayed.<br /><br />The authors conclude that in cirrhotic patients with abdominal pain after paracentesis, clinicians should maintain a high index of suspicion for NF, start broad-spectrum antibiotics immediately, and obtain emergent surgical consultation, since early debridement is critical to survival.

Asset Subtitle

Elaine Ognjanovski

Meta Tag

Author List Cassie Konja, Elaine Ognjanovski, Kaiser Kabir, Niketh Chopra, Rossteen Abbasi

Category Clinical Vignettes

Concept Necrotizing Fasciitis

Concept Surgical Debridement

Concept Rapid Progression

Concept Cirrhosis

Concept Broad-Spectrum Antibiotic

Distinguished Non-Finalist

Presenter Organization Henry Ford Warren Internal Medicine

Presenting Author Elaine Ognjanovski

Track Adult

Keywords

necrotizing fasciitis

abdominal wall infection

paracentesis complication

decompensated cirrhosis

hepatic encephalopathy

septic shock

subcutaneous air

surgical debridement

multidrug-resistant Klebsiella pneumoniae

broad-spectrum antibiotics

Necrotizing Fasciitis

Surgical Debridement

Rapid Progression

Cirrhosis

Broad-Spectrum Antibiotic