Giant Ulcer with Necrosis on Right Vulva, Groin, and Thigh-- A Case of Necrotizing Fasciitis Associated with Erythematous Pemphigus

Abstract

Necrotizing fasciitis is a rare, severe, rapidly progressing disease with a high mortality rate. We report a case of a 72-year female with erythematous pemphigus who developed erythema, swelling and ulceration on right vulva, groin, and thigh. The early clinical manifestations of the patient were nonspecific and easily misdiagnosed as cellulitis. However, upon the occurrence of ulceration and necrosis, deep fungal infection, pyoderma gangrenosum or lymphoproliferative disorders were considered. The pathology suggested IgG4-related diseases, plasmacytoma et al. But at last, surgical exploration and postoperative pathology confirmed the diagnosis of necrotizing fasciitis. The patient recovered after multiple aggressive surgical debridement procedures and antibiotic therapy and the patient has been followed up for 2 years without recurrence. Clinicians should be vigilant about the possibility of necrotizing fasciitis in patients with erythema, pain, rapid ulceration of skin and soft tissue, particularly in immunocompromised individuals with long-term use of immunosuppressive agents. It is crucial for saving life by early multi-disciplinary consultation, prompt diagnosis, and aggressive treatment.

Keywords:

• debridement
• infection
• multidisciplinary consultation
• necrotizing fasciitis
• pemphigus

Consent Statement

Written informed consent was obtained from the patient to have the case details and associated images published. Our manuscript does not need any institutional approval to publish the case details.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work is supported by Spreading Wings Program Research Fund of the first people’s hospital of Changde city (Grant ID:2023ZC04) and Changde City Science and Technology Innovation Guidance Project (Grant ID:2023ZD34).