dermatologic disorders
Necrotizing Soft Tissue Infection
Symptoms and Signs of Necrotizing Soft Tissue Infection
The primary symptom of NSTI is intense pain. In patients with normal sensation, pain out of proportion to clinical findings may be an early clue. However, in areas denervated by peripheral neuropathy, pain may be minimal or absent. Affected tissue is warm, erythematous, and swollen and rapidly becomes discolored. Bullae, crepitus (resulting from soft-tissue gas), and gangrene may develop. Subcutaneous tissues (including adjacent fascia) necrose, with widespread undermining of surrounding tissue. Muscles may be spared initially but can be involved as the disorder progresses. Patients are acutely ill, with high fever, tachycardia, altered mental status ranging from confusion to obtundation, and hypotension. Patients may be bacteremic or septic and may require aggressive hemodynamic support. Streptococcal toxic shock may develop. 