Successful treatment of necrotising fasciitis following cobra bite: a case report.

IF 0.4 Q4 SURGERY
Journal of Surgical Case Reports Pub Date : 2025-05-20 eCollection Date: 2025-05-01 DOI:10.1093/jscr/rjaf309
Santosh Dev, Amit Yadav, Prajjwol Luitel, Barsha Dev, Gyaneshwor Shrestha, Badal Karki
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引用次数: 0

Abstract

Necrotising fasciitis following cobra envenomation is an infrequent but life-threatening complication. We report a case of a 72-year-old woman from Khotang who developed a rapidly progressive, discharging wound on her right foot 3 days after sustaining a cobra bite. Initially treated at a local snakebite center with 30 vials of antivenom, she later presented with tachycardia, low-grade fever, and leukocytosis. Local tissue culture revealed Streptococcus pyogenes, prompting escalation of antibiotics to Piperacillin-Tazobactam. The ensuing extensive tissue necrosis, driven by venom cytotoxicity, facilitated secondary bacterial colonization. Aggressive resuscitation, repeated surgical debridement, and nutritional support with a high-protein diet and multivitamins resulted in robust granulation tissue formation. Definitive reconstruction was achieved with a split-thickness skin graft. This case underscores that while antivenom reverses systemic toxicity, early recognition and prompt surgical intervention are paramount in preventing the devastating progression of local necrosis to necrotising fasciitis.

眼镜蛇咬伤后坏死性筋膜炎的成功治疗一例。
眼镜蛇中毒后的坏死性筋膜炎是一种罕见但危及生命的并发症。我们报告了一个来自Khotang的72岁妇女的病例,她在被眼镜蛇咬伤3天后,右脚出现了一个迅速进展的伤口。最初在当地蛇咬伤中心接受了30瓶抗蛇毒血清治疗,后来出现了心动过速、低烧和白细胞增多。局部组织培养显示化脓性链球菌,促使抗生素升级到哌拉西林-他唑巴坦。随后广泛的组织坏死,由毒液细胞毒性驱动,促进继发性细菌定植。积极的复苏,反复手术清创,以及高蛋白饮食和多种维生素的营养支持导致了强健的肉芽组织形成。通过裂厚皮肤移植获得了最终的重建。该病例强调,虽然抗蛇毒血清可逆转全身毒性,但早期识别和及时手术干预对于防止局部坏死发展为坏死性筋膜炎至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.70
自引率
0.00%
发文量
559
审稿时长
11 weeks
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