فاشئیت نکروان: یک علت نادر برای درد قفسه سینه و شورک کاردیوژنیک – یک گزارش موردی بالینی

Backgrounds: Chest pain is one of the most common reasons for referring to emergency departments. Finding the cause of chest pain has always been difficult for clinicians. Necrotizing fasciitis is an infrequent and life-threatening soft tissue infection, which could involve skin, fascia, and muscles rapidly. Clinical manifestations usually include local redness, tenderness, and edema.Case presentation: A ۶۰-year-old man without any prior medical history presented to the emergency department because of severe, continuous, exertional, compressive, left-sided chest pain, which radiated to left hand, and relieved with nitroglycerine pearl. He also mentioned cold sweating and nausea. The patient denied any history of fever, dyspnea, palpitation, and chest trauma. His systolic blood pressure was below ۹۰ mmHg. ECG showed no specific changes in favor of ischemia. Echocardiography demonstrated severe left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF): ۱۵-۲۰%). He was transferred to a tertiary hospital due to cardiogenic shock. On arrival, his blood pressure was ۸۰/۵۵ while taking norepinephrine, his pulse rate was ۱۰۳ beats per minute, and the temperature was ۳۶.۹ °C. He underwent coronary angiography, which showed significant stenosis in the mid-part of the left anterior descending (LAD). Although this stenosis was not convincing for his clinical presentations, the percutaneous coronary intervention was successfully performed on LAD. Additionally, normal aortography and low d-dimer level ruled out aortic dissection and pulmonary thromboembolism. The C-reactive protein level was ۵۶ mg/dl, and the white blood cell (WBC) count was ۱۰,۴۰۰. Therefore, empiric antibiotic therapy was started because of sepsis shock. The day after, a bullae appeared in the left axilla and ruptured with necrotic borders. The patient underwent surgical debridements and wide-broad spectrum antibiotic therapy because of necrotizing fasciitis on his axilla. A biopsy of the wound confirmed this diagnosis. After one month, the patient`s echocardiography showed that LVEF was ۵۵%. Conclusion: In conclusion, necrotizing fasciitis in the chest wall could be a rare but fatal differential diagnosis of chest pain. Because of the rapid progression and high mortality rate, prompt diagnosis and treatment of necrotizing fasciitis is life-saving.

کلیدواژه ها:

Chest pain ، cardiogenic shock ، necrotizing fasciitis