General surgery
Maryam Yousefi; Fariba Yarandi; Elham Shirali; Shahab Rajabzadeh; Pershang Nazemi
Articles in Press, Accepted Manuscript, Available Online from 07 February 2024
Abstract
We reported a 55-year-old woman with a history of recent surgery presented to the emergency room with complaints of erythema and foul-smelling discharge from her surgical incision site. Upon examination in the emergency room, the surgical incision site was promptly opened, thoroughly cleaned with a sizable ...
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We reported a 55-year-old woman with a history of recent surgery presented to the emergency room with complaints of erythema and foul-smelling discharge from her surgical incision site. Upon examination in the emergency room, the surgical incision site was promptly opened, thoroughly cleaned with a sizable amount of sterile normal saline, and evaluated and cultures were sent for microbiological and histological evaluation. The patient was promptly initiated on a combination antibiotic regimen, including ceftazidime, levofloxacin, metronidazole, and vancomycin, under the guidance of the infectious disease team. Fungal mycelium was found in the smear of wound discharge in recent microbiological exam. In response to the suspected fungal infection, fluconasol was promptly added to the treatment regimen to combat the fungal pathogen. According to result of microbiological cultures, non-albicans candida and its resistance to fluconasol, caspofungin was substituted. Patient's condition dramatically improved with the combined treatment of meropenem and caspofungin. The development of necrotizing fasciitis in this patient's case added a critical layer of complexity to an already challenging clinical scenario. The rapid recognition, aggressive surgical intervention, and targeted antimicrobial therapy collectively played a pivotal role in her successful recovery. This case underscores the importance of vigilance in monitoring postoperative patients, particularly those with risk factors, and highlights the need for a multidisciplinary approach in managing this severe soft tissue infection.
