Abstract
Background
Necrotizing fasciitis is a life-threatening soft-tissue infection, often characterized
by soft-tissue destruction, systemic toxicity, and high mortality. No single laboratory
value can diagnose necrotizing fasciitis; ultimately, necrotizing fasciitis is a clinical
diagnosis and therefore presents a diagnostic dilemma for many physicians. The finger
probe test is useful in confirming the diagnosis when imaging studies are unobtainable
or nondiagnostic.
Case Report
We present the case of a 70-year-old woman presenting nonverbal and obtunded with
a soft-tissue infection of the right lower extremity. The only pertinent positive
vital sign was tachypnea with a respiratory rate of 22 breaths/min. Physical examination
revealed nonpitting edema, cold-to-touch lower extremity, and Nikolsky-positive hemorrhagic
bullae. Initial laboratory test results showed white blood cell count of 38 x 109/L and lactic acid of 8.2 mg/dL. Advanced imaging was unobtainable, given the patient's
worsening clinical status, and the decision was made to perform the finger probe test,
which revealed absence of bleeding and presence of friable tissue and “dishwater”
discharge. Consequently, the general surgery team took the patient to the operating
room and performed an above-the-knee amputation and surgical debridement. Postoperative
report noted nonviable tissue consistent with necrotizing fasciitis.
Why Should an Emergency Physician Be Aware of This?
Necrotizing fasciitis is a life-threatening emergency that can destroy soft-tissue
at a rate of 1 inch/h. When imaging is unobtainable or nondiagnostic, the finger probe
test can be used in select patients to aid with diagnosis.
Keywords
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References
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- Validation of finger test for necrotising soft tissue infection [published online ahead of print October 7, 2020].J Orthop Trauma Rehab. 2020; https://doi.org/10.1177/2210491720961546
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Article info
Publication history
Published online: May 09, 2022
Accepted:
April 23,
2022
Received in revised form:
March 8,
2022
Received:
October 3,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
