Sacral Decubitus Ulcer as an Unusual Presentation of a Necrotizing Soft Tissue Infectio

Author(s):
Vishal Patel; Daniel Matienzo; Shaikh Hai

Background:

Introduction: 

Necrotizing soft tissue infections (NSTIs) include a broad spectrum of infections that can cause significant morbidity and mortality in patients. Difficulty diagnosing and the rapidly progressive nature of NSTIs make treatment particularly difficult and outcomes devastating. Although pressure sores and ulceration that develop in bed bound and critically ill patients are common, development of chronic ulcers into NSTIs are exceedingly rare. There is limited literature available on pressure ulcers presenting as a NSTI.

Methods:

Results:

Case description:

This is a case of a 69-year-old African American female with a past medical history of insulin dependent Diabetes Mellitus, dementia, and coronary artery disease presenting from an assisted living facility with severe sepsis secondary to a large stage 4 sacral ulcer with purulent discharge and a foul smell. The patient was administered broad spectrum antibiotics for septic shock and urgently taken for operative debridement of the 20x21x5cm NSTI down to the sacrum. She remained intubated on maximal vasopressor therapy in the ICU. A second look procedure for additional debridement was performed 36 hours following initial debridement. Surgical cultures identified multiple Gram-Negative Bacilli and Blood cultures grew Morganella morganii and Proteus mirabilis. The patient continued to deteriorate until she expired 6 days after being admitted.

Conclusions:

Discussion:

This case demonstrates the difficulty in early recognition of NSTIs in chronic pressure ulcers and the consequences of delay in care.