Zara Khan and Sujan Kumar Sen
Leeds University, School of Medicine, Hull & East Yorkshire NHS Foundation Trust, UK
Posters & Accepted Abstracts: J Sleep Disord Ther
Introduction: This case presents the development of a rare inflammatory infection, with reported mortality rates of up to 80%. It describes the patients clinical presentation, investigations and management as well as exploring the various factors that led to this preventable condition. Case description: A 33 year old female, with a background of poorly controlled diabetes, obesity, hypercholesterolaemia and depression, presented to her general practitioner with a two week history of unresolving unilateral vulval swelling. She was referred to the gynaecology team via accident & emergency and blood tests on admission revealed elevated inflammatory markers (CRP 370, WCC 27.7, Neutrophils 23.58) along with a HbA1c of 114. Clinically, she had a raised temperature and was tachycardic; coupled with the blood results, she was deemed as being septic. She was commenced on intravenous antibiotics and had emergency debridement of the left labia, pubic region and perineum. Discussion: This case reinforces diabetes as a major risk factor for developing necrotising fasciitis and therefore highlights the importance of early diagnosis and thus low threshold for referral in such patients. The patient in this case has a 10 year history of poorly controlled diabetes which is attributed to non-compliance with medication, depressive mental state and work related stress. All of the aforementioned factors contribute to the holistic nature of a patients disease and the impact it has on their health and well being. This case teaches an important lesson of understanding the underlying factors that build up to a devastating end point.
I am a foundation trainee doctor working in the Hull and East Yorkshire NHS Foundation Trust, having graduated from the University of Leeds medical school, MBChB. I am currently working in an inner city general practice in Hull, which serves a population of 10, 000 patients. I am in the process for applying for general practice specialty training.
Eamil: zara.khan1@nhs.net
