A rare case of necrotizing fasciitis of the leg in an intravenous drug user caused by Prevotella denticola

Figures & data

Figure 1. Left calf of a IDU patient: evidence of swelling and ecchymosis in the site of cocaine injection; hyperpigmentation and chronic scarring (skin popping scars) in the distal leg area.

Figure 2. CT scan of the left leg (sagittal scans): evidence of large subfascial abscess (a) and multiple air bubbles in the sub- and supra-fascial soft tissues (b).

Figure 3. Culture on anaerobic medium (schaedler agar) from intraoperative specimens collected during fasciotomy of the leg.

Figure 4. Growth of Gram-negative bacilli on anaerobic medium from intraoperative specimens collected during fasciotomy of the leg.

Table 1. The laboratory risk indicator for necrotizing fasciitis score (based on [5]).

Variable	Value	Score
C-Reactive protein (mg/L)	≤150	0
	>150	4
Total white blood cell count (10 [3] cells/µL)	<15	0
	15–25	1
	>25	2
Hemoglobin (g/dL)	>13.5	0
	11–13.5	1
	<11	2
Sodium (mmol/L)	≥135	0
	<135	2
Creatinine (mg/dL)	≤1.6	0
	>1.6	2
Glucose (mg/dL)	≤180	0
	>180	1

Table 2. LRINEC risk assessment (based on [5]).

Risk Category	LRINEC Points	Probability for Presence of NF
Low	≤5	<50%
Medium	6–7	50–75%
High	≥8	>75%

Figure 5. Orthopantomography of the IDU patient: signs of periodontal disease, with a thin periodontal pocket at the implantation of a tooth element.

Wong CH, Khin LW, Heng KS, et al. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–1541. doi: 10.1097/01.ccm.0000129486.35458.7d

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Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am. 2002 Sep;16(3):697–712. doi: 10.1016/s0891-5520(02)00017-x PMID: 12371123.

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Data availability statement

The data supporting this paper are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are in controlled access data storage at AOU ‘Policlinico di Modena’.