MED-2. A case of recurrent necrotizing fasciitis.

In December 2002, a 60-year-old male with no significant past medical history presented to the emergency department with a left medial thigh mass which was first noted the day prior and had progressively become more erythematous and tender with fever and chills. The pain became so severe he had difficulty ambulating. The patient was admitted and started on nafcillin and levofloxacin. He continued to worsen and emergent surgical consultation was obtained and the patient was taken to operating room for excision, debridement and drainage of the medial thigh as he was found to have necrotizing fasciitis. He recovered without complication until 7 months later when he presented with sudden onset of pain at the debridement site. The patient was started on penicillin, vancomycin, and clindamycin. General surgery was consulted and the patient was taken to surgery where necrotizing fasciitis was again diagnosed. The patient subsequently recovered and at this time remains asymptomatic. Necrotizing fasciitis is considered a rare soft tissue infection notable for widespread fascial necrosis with a broad range of organisms identified as etiologic agents. We report the first case of recurrent necrotizing fasciitis in a patient with no known risk factors.

CAPT Dara D. Bagwell, MD, and MAJ Michael Forgione, MD. Keesler Air Force Base Medical Center, Biloxi, MS.