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나가혜 ( Ga Hye Na ),박건 ( Kun Park ),김은정 ( Eun Jung Kim ) 대한피부과학회 2017 대한피부과학회지 Vol.55 No.7
Background: Necrotizing fasciitis is a life-threatening soft tissue infection involving the fascia and subcutaneous tissues. Diagnosis of necrotizing fasciitis is often delayed because of an underestimation or an overlap between it and cellulitis. Objective: We aimed to evaluate and compare the clinical, laboratory, and microbiological characteristics of cellulitis and necrotizing fasciitis. Methods: We retrospectively reviewed medical records of patients diagnosed as having cellulitis or necrotizing fasciitis and hospitalized at our hospital between January 2011 and December 2016. Results: The study included data from 185 patients having cellulitis and 33 patients having necrotizing fasciitis. There were significant differences between cellulitis and necrotizing fasciitis regarding clinical and laboratory factors. Necrotizing fasciitis was primarily associated with the following features at the time of admission: A thigh/buttock location [odds ratio (OR) 9.04, 95% confidence interval (CI) 1.72∼47.64, p=0.009], pain not controlled with use of non-opioid analgesics (OR 6.26, 95% CI 2.21∼17.71, p<0.001), serum sodium level <135 mEq/L (OR 17.44, 95% CI 7.27∼41.84, p<0.001), and a serum procalcitonin level >0.32 ng/mL (OR 9.41, 95% CI 4.18∼21.93, p <0.001). Additionally, polymicrobial infections and Gram-negative organisms were more commonly associated with necrotizing fasciitis compared to cellulitis. Conclusion: We found several differences between cellulitis and necrotizing fasciitis in terms of clinical, laboratory, and microbiological characteristics. When patients showing symptoms of cellulitis present with lesions on the thigh or buttock, pain not controlled with use of non-opioid analgesics, a serum sodium level <135 mEq/L, or a procalcitonin level >0.32 ng/mL, it would be appropriate to evaluate for the possibility of necrotizing fasciitis and use broad-spectrum antibiotics to cover for Gram-negative organisms. (Korean J Dermatol 2017;55(7):410∼420)
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김의중 ( Eui Joong Kim ),주민수 ( Min Su Chu ),손기창 ( Ki Chang Sohn ),조동호 ( Dong Ho Cho ),나가혜 ( Ga Hye Na ),김학철 ( Haak Cheoul Kim ),조은영 ( Eun Young Cho ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.1
Pancreatic panniculitis is a rare complication characterized by subcutaneous fat necrosis associated with pancreatic disease. It has been postulated that pancreatic panniculitis is caused by the systemic activity of pancreatic enzymes that lead to microcirculatory disturbances. We report a 41-year-old heavy alcoholic woman with pancreatic panniculitis that coexisted with acute and chronic pancreatitis. She was diagnosed with chronic pancreatitis and alcoholic liver cirrhosis 5 years ago. She presented with multiple, tender, erythematous, subcutaneous nodules with heat sensation on both lower legs. Laboratory evaluation revealed an increase in the serum blood amylase and lipase. Histopathologic findings showed fat necrosis with inflammation around the necrotic subcutaneous fat tissue. The lesions subsided gradually with an improvement of acute pancreatitis. (Korean J Gastroenterol 2017;69:83-86)
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