A rare case of necrotizing fasciitis of the leg in an intravenous drug user caused by Prevotella denticola

Abstract

Background

Intravenous drug users (IDUs) have a high risk of developing skin and soft tissue infections such as erysipelas, abscesses, and less frequently necrotizing fasciitis (NF) or gas gangrene. Rarely, the cause of the infection is microorganisms residing in the oral cavity and can lead to life-threatening infections.

Methods

We describe the case of a 43-year-old man intravenous drug user (IDU) who was admitted for intense leg pain following an injection of cocaine at that site.

Results

A clinical and radiological diagnosis of NF was made, so the patient was started on empirical antibiotic therapy and underwent surgical fasciotomy (after 8 hours from admission). Prevotella denticola was isolated from multiple intraoperative specimens and was resistant to initial antimicrobial therapy. The man, suffering from periodontal disease, reported sucking the syringe several times to unblock it. Both fasciotomy surgery and adjustment of antimicrobial therapy enabled therapeutic success.

Conclusions

In IDUs the risk of deep skin and soft tissue infections is high and may be aggravated by contamination with oral microorganisms. The choice of empirical antibiotic treatment should include agents active against oral cavity anaerobes, such as P. denticola.

Keywords:

• ABSSSIs
• anaerobes
• LRINEC Score
• intravenous drug user
• skin infections
• abscesses

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data supporting this paper are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are in controlled access data storage at AOU ‘Policlinico di Modena’.

Ethical approval

Not applicable (our Institution’s ethics committee does not provide approval for case reports)

Additional information

Funding

No funds received