RESUMO
La fascitis necrotizante es una infección grave que cursa con necrosis de los tejidos y afectación sistémica, con un curso rápido y desenlace fatal. Aunque es una entidad poco frecuente debe ser sospechada y tratada con celeridad, porque de ello depende el pronóstico. El tratamiento se basa en la actuación quirúrgica inmediata, antibioterapia de amplio espectro y medidas de soporte en una unidad de cuidados críticos. Presentamos el caso de una paciente que ingresó en reanimación tras desbridamiento quirúrgico por sospecha de fascitis necrotizante y que presentaba además una inmunodeficiencia común variable o hipogammaglobulinemia caracterizada por un déficit de linfocitos B y tratamiento con metotrexato por enfermedad de Crohn. Ambas producían déficit inmunológico. Tras 11 días de tratamiento pudo ser dada de alta con mejoría clínica, analítica y hemodinámica(AU)
Necrotizing fasciitis is a severe infection that leads to necrosis of the tissues and systemic involvement, with a rapid progress and a fatal outcome. Although this condition is rare, it must be suspected and rapidly treated, as the prognosis depends on this. The treatment is based on immediate surgery, wide spectrum antibiotic treatment, and support measures in a critical care unit. We present the case of a patient who was admitted to Recovery room after surgical debridement due to suspicion of fasciitis. The patient also had a common variable immunodeficiency or hypogammaglobulinaemia, characterised by a B lymphocyte deficiency, as well as on treatment with methotrexate for Crohn's disease. Both produced an immune deficiency. After 11 days of treatment there was a clinical, analytical and haemodynamic improvement, and she was discharged(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fasciite Necrosante/complicações , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/metabolismo , Metotrexato/uso terapêutico , Terapia de Imunossupressão/instrumentação , Terapia de Imunossupressão/métodos , Terapia de Imunossupressão , Cuidados Críticos/métodos , Cuidados CríticosRESUMO
Necrotizing fasciitis is a severe infection that leads to necrosis of the tissues and systemic involvement, with a rapid progress and a fatal outcome. Although this condition is rare, it must be suspected and rapidly treated, as the prognosis depends on this. The treatment is based on immediate surgery, wide spectrum antibiotic treatment, and support measures in a critical care unit. We present the case of a patient who was admitted to Recovery room after surgical debridement due to suspicion of fasciitis. The patient also had a common variable immunodeficiency or hypogammaglobulinaemia, characterised by a B lymphocyte deficiency, as well as on treatment with methotrexate for Crohn's disease. Both produced an immune deficiency. After 11 days of treatment there was a clinical, analytical and haemodynamic improvement, and she was discharged.
