Necrotizing fasciitis is a condition that can be treated only through surgery and that can become deadly within a very short amount of time. Although there are certain classic symptoms unique to necrotizing fasciitis some symptoms, especially in the early stages, can easily be mistaken as being due to cellulitis. In certain cases it is critical for doctors who examined a patient with such symptoms to conduct tests in order to determine the actual cause of the symptoms, especially in situations where the patient is immuno-compromised. Not doing so could allow enough time to pass for necrotizing fasciitis to spread to the point where it is fatal for the patient.
In one documented case a 46-year-old male lupus patient went to see his rheumatologist after several days with a fever. His doctor admitted him to a local hospital for observation and testing. Blood tests showed that he had a highly lowered WBC. Even though the staff put the man on an IV when he was admitted there was no entry in his chart showing that he had an IV. Because the start of the IV had not been documented it was not until four days later, on the night before he was to go home, that the IV was moved to the other arm. This only happened because the man complained multiple times of pain in the forearm in the area of the IV. When the nursing staff told the attending doctor, the doctor examined the site, concluded that it was cellulitis, and ordered antibiotics but discharged the man.
By the end of that same day the man experienced greater pain at the site of the original IV. The site had also become swollen. In addition several abscesses had formed at the site. The man went to the emergency room where a doctor diagnosed him as having necrotizing fasciitis. This required emergency debridement (the surgical removal of the dead and infected portions) of the forearm at the site of the original IV. Insufficient tissue was removed during the debridement and the infection kept spreading. Eventually the doctors amputated his arm. Again the infection continued to spread and the man died roughly 24 hours later.
The man’s family pursued a medical malpractice lawsuit alleging that the lack of documentation concerning the IV had caused a multi-day delay in changing the site of the IV by the nursing staff and that the man had been improperly discharged when the doctor concluded he had cellulitis without testing. In an attempt to defend the case the defendants argued (1) that no error had been committed, (2) that it had been appropriate to discharge the man given the nature of the symptoms he displayed at the time, (3) that the nature of necrotizing fasciitis is such that earlier treatment would not have made a difference, (4) that because the man was unemployed at the time there was no loss of earning capacity, and (5) that his general health was such that he is life expectancy was no more than five years. The law firm that handled this case reported, however, that they were able to achieve a settlement for $675,000 on behalf of the man’s family.
This case illustrates that even though a person with early stage necrotizing fasciitis may exhibit symptoms that resemble those of cellulitis and that cellulitis is much more common, it is nonetheless important to run diagnostic testing in order to determine the difference. This is especially true given the deadly nature of necrotizing fasciitis. In addition, if surgery for necrotizing fasciitis does not remove all of the infected tissue it will continue to spread and can become fatal in a short amount of time.