Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges.
Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.
['Fais|Paolo|P|', 'Viero|Alessia|A|', 'Viel|Guido|G|http://orcid.org/0000-0002-9769-535X', 'Giordano|Renzo|R|', 'Raniero|Dario|D|', 'Kusstatscher|Stefano|S|', 'Giraudo|Chiara|C|', 'Cecchetto|Giovanni|G|', 'Montisci|Massimo|M|']
D000328:Adult D003933:Diagnosis D019115:Fasciitis, Necrotizing D005260:Female D049429:Forensic Pathology D006801:Humans D007558:Italy D008297:Male D008875:Middle Aged D012189:Retrospective Studies D018461:Soft Tissue Infections
Necrotizing fasciitis Medical malpractice Clinical forensic medicine Forensic pathology LRINEC score