SHM Converge Scientific Abstract ePoster Gallery-Teamwork Makes the Dream Work: A Collaborative Case in Recognizing and Treating Necrotizing Soft Tissue Infection

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This case highlights the importance of vigilance, repeated reassessment, and collaboration in diagnosing and treating necrotizing soft tissue infections (NSTIs), which are often mistaken for cellulitis or abscesses. NSTIs are rare but highly lethal infections, with mortality rising dramatically when diagnosis or treatment is delayed. Early surgical debridement is critical, ideally within 12 hours.<br /><br />A 55-year-old man with diabetes and a remote history of IV drug use presented with a one-week history of right chest wall erythema, pain, fever, chills, poor appetite, and weight loss. Initial CT imaging at an outside hospital showed swelling and edema without abscess, and he briefly improved on ceftriaxone. However, persistent pain and leukocytosis led to transfer for possible surgical management. On arrival, no clear surgical indication was found, so he was admitted to medicine for continued antibiotics.<br /><br />Within 12 hours, the patient worsened significantly, developing rapidly expanding chest wall swelling and severe pain with rigidity of the right pectoralis muscle. Although his vital signs remained stable, the physical exam and clinical deterioration raised concern for NSTI. Antibiotics were broadened to vancomycin, ertapenem, and clindamycin, and surgery plus radiology were urgently involved. Imaging was obtained, and the patient was taken immediately to the operating room.<br /><br />During surgery, 400 cc of pus was drained from beneath the pectoralis muscle and fractured ribs were removed. Cultures grew Streptococcus agalactiae, an unusual cause of NSTI. He was diagnosed with a deep necrotizing soft tissue infection complicated by osteomyelitis and completed prolonged antibiotic therapy with IV ceftriaxone followed by amoxicillin/clavulanate.<br /><br />The case emphasizes that hospitalists must recognize evolving surgical emergencies early and that strong interdepartmental collaboration can significantly improve outcomes.

Asset Subtitle

Anthony Dao

Meta Tag

Author List Anthony Dao

Category Clinical Vignettes

Concept Necrotizing Soft Tissue Infection

Concept Surgical Debridement

Concept Surgical Emergency

Concept Pain out of proportion

Concept Surgical Consultation

Distinguished Non-Finalist

Presenter Organization Washington University

Presenting Author Anthony Dao

Track Adult

Keywords

necrotizing soft tissue infection

NSTI

cellulitis

abscess

early surgical debridement

vigilance

reassessment

collaboration

Streptococcus agalactiae

osteomyelitis

Necrotizing Soft Tissue Infection

Surgical Debridement

Surgical Emergency

Pain out of proportion

Surgical Consultation