Necrotizing fasciitis caused by the treatment of chronic non-specific back pain
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CASE REPORT
Open Access
Necrotizing fasciitis caused by the treatment of chronic non-specific back pain Lilit Floether1* , Michael Bucher1, Ralf Benndorf2 and Anna-Maria Burgdorff1
Abstract Background: Chronic back pain is a multifactorial disease that occurs particularly in adults and has many negative effects on the quality of daily life. Therapeutic strategies are often multimodal and designed for a long-term therapy period. In some cases, one option is joint infiltration or intrathecal injection with local anaesthetics. An adverse effect of this intervention may be necrotic fasciitis, a disease with high mortality and few therapeutic options. Case presentation: This case shows a 53-year-old female patient who developed necrotic fasciitis after infiltrations of the sacroiliac joint and after epidural-sacral and intrathecal injections. Conclusion: Thanks to early and aggressive surgical intervention, antibiotic treatment and hyperbaric oxygenation, she survived this serious complication and was able to return to life. Keywords: Chronic back pain, Necrotizing fasciitis, Hyperbaric oxygenation, Infiltration
Background Chronic back pain is a worldwide disease that affects 70–80% of all adults during their life. Due to the duration and persistence of pain, it is associated with a significant disability in everyday life as well as a high psychosocial burden. This leads to high health care costs, absenteeism and economic burden [1, 2]. Due to the complexity of chronic non-specific back pain, curative therapy usually consists of a multimodal concept. In the national German guidelines for the treatment of non-specific back pain, various non-drug measures (exercise therapy, acupuncture, psychological care) and drug measures (non-opioid analgesics, opioids) are recommended, whereby no recommendation could be given for invasive or intramuscular (subcutaneous) application [3]. Similarly, the European Guidelines for management of chronic nonspecific low back pain do not recommend epidural corticosteroids, intra-articular (facet) steroid injections and some other invasive * Correspondence: [email protected] 1 Department of Anesthesiology and Surgical Intensive Care, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany Full list of author information is available at the end of the article
treatments [4]. A necrotizing fasciitis may be a possible, albeit very rare, complication of such an invasive procedure. Causes of necrotizing fasciitis are usually bacterial infections (often beta-hemolytic Group A Streptococci or mixed infections) through injuries to the skin, e.g. punctures or perforations. Risk factors are diseases that often lead to microtrauma of the skin or wound infections, such as peripheral arterial disease, diabetes mellitus or obesity. Its course is characterized by a rapid progression and a high mortality rate of about 20% [5]. The therapeutic strategies of necrotizing fasciitis include early surgical intervention, antibiotic therapy and adjuvant measures such as hyp
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