Necrotizing cellulitis

Background

• Pts are often much less toxic compared with necrotizing fasciitis/necrotizing myositis
• Two types:
  • Anaerobic infection (clostridial and nonclostridial)
  • Meleney's synergistic gangrene
    • Rare infection that occurs in postop patients
    • Characterized by slowly expanding indolent ulceration that is confined to superficial fascia
    • Results from synergistic interaction between S. aureus and microaerophilic streptococci

Risk Factors

• Trauma
• Surgical contamination
• Spread of infection from bowel to perineum, abdominal wall, or lower extremities

Clinical Features

• Thin, dark, sometimes foul-smelling wound drainage (often containing fat globules)
• Tissue gas formation (crepitus)

Differential Diagnosis

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Management

• Same as Necrotizing Fasciitis

Disposition

• Admit/OR

See Also

• Necrotizing soft tissue infections