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At least 19 recordsLinked to original sources
PubMed2004

The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections.

OBJECTIVE: Early operative debridement is a major determinant of outcome in necrotizing fasciitis. However, early recognition is difficult clinically. We aimed to develop a novel diagnostic scoring system for distinguishing necrotizing fasciitis from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections: the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. DESIGN: Retrospective observational study of patients divided into a developmental cohort (n = 314) and validation cohort (n = 140) SETTING: Two teaching tertiary care hospitals. PATIENTS: One hundred forty-five patients with necrotizing fasciitis and 309 patients with severe cellulitis or abscesses admitted to the participating hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The developmental cohort consisted of 89 consecutive patients admitted for necrotizing fasciitis. Control patients (n = 225) were randomly selected from patients admitted with severe cellulitis or abscesses during the same period. Hematologic and biochemical results done on admission were converted into categorical variables for analysis. Univariate and multivariate logistic regression was used to select significant predictors. Total white cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein were selected. The LRINEC score was constructed by converting into integer the regression coefficients of independently predictive factors in the multiple logistic regression model for diagnosing necrotizing fasciitis. The cutoff value for the LRINEC score was 6 points with a positive predictive value of 92.0% and negative predictive value of 96.0%. Model performance was very good (Hosmer-Lemeshow statistic, p =.910); area under the receiver operating characteristic curve was 0.980 and 0.976 in the developmental and validation cohorts, respectively. CONCLUSIONS: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis. The variables used are routinely measured to assess severe soft tissue infections. Patients with a LRINEC score of > or = 6 should be carefully evaluated for the presence of necrotizing fasciitis.

Abscess↗
PubMed1982

Nodular fasciitis (pseudosarcomatous fasciitis) of the vulva.

Nodular fasciitis (pseudosarcomatous fasciitis) is a benign nonneoplastic connective tissue proliferation of unknown pathogenesis, which most commonly involves the upper limb subcutaneous fascia. Nodular fasciitis of the vulva is an entity rarely encountered by gynecologists or pathologists, but has considerable potential for misdiagnosis as sarcoma and for inappropriate treatment. The patient, a 32-year-old black female, presented with a 3-cm right labial mass, which was nodular, rubbery, and yellowish-white on section. Microscopically, there was an admixture of large mesenchymal cells, small blood vessels, and lymphocytes in a sparsely collagenous matrix. Other features included extravasated erythrocytes, intercellular clefts, and pseudocysts. Although mitoses were common (8 per 10 high power fields), there were no atypical mitoses and no bizarre tumor giant cells. The large mesenchymal cells were identified by electron microscopy as myofibroblasts, cells which abound in a variety of other reactive and non-neoplastic conditions. It is important not to misdiagnose nodular fasciitis as a vulvar sarcoma, because nodular fasciitis requires only simple excision and does not recur or metastasize.

Adult↗
PubMed1994

Identification of Borrelia burgdorferi in diffuse fasciitis with peripheral eosinophilia: borrelial fasciitis.

OBJECTIVE: To determine if spirochetes could be localized in biopsy specimens of patients with diffuse fasciitis and peripheral eosinophilia. PATIENTS: Tissue from two patients received in consultation and retrieved from hospital files. One patient had a history of tick bite and erythema migrans. SETTING: Tertiary care center and pathology consultation practice. METHODS: Multiple tissue sections were examined for spirochetes using the modified Dieterle or Steiner technique. One case was examined using rabbit polyclonal antibodies against Borrelia burgdorferi. One case had sufficient tissue to study for B burgdorferi DNA by polymerase chain reaction. RESULTS: We identified two cases of diffuse fasciitis associated with peripheral eosinophilia in which spirochetal organisms were identified. The two patients had positive or borderline B burgdorferi serological findings. Deep biopsy was diagnostic of diffuse fasciitis with eosinophilia. In one patient, multiple organisms were seen using a modified Dieterle silver stain, and B burgdorferi-specific DNA was amplified by polymerase chain reaction. In the other patient, no unequivocal organisms were detected on silver stain; however, organisms were detected using rabbit polyclonal antibodies against B burgdorferi. CONCLUSION: Some cases of what has previously been described as "eosinophilic" fasciitis may be an expression of Lyme disease, and we propose the more specific term borrelial fasciitis to describe such lesions.

Antibodies, Bacterial↗
PubMed2005

A case of necrotizing fasciitis caused by coagulase-negative staphylococcus: utility of magnetic resonance imaging for the preoperative diagnosis of necrotizing fasciitis.

A 70-year-old woman presented with fever and pain in the right lower extremity. Fat-suppressed gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) showed contrast-enhanced fascia, fluid accumulation, and hypointense signals in the muscles. Surgical interventions including incisions and insertion of drainage tubes were performed on the basis of the MRI findings. The histopathological examinations of surgically obtained biopsy specimens demonstrated suppurative fasciitis, widespread myonecrosis, and thromboses of the vessels, all of which were compatible with a diagnosis of necrotizing fasciitis. The bacterial cultures were positive for a coagulase-negative staphylococcus. Following the surgical interventions, the patient was successfully treated by aggressive antimicrobial therapy. MRI can thus be useful for differentiating necrotizing fasciitis from nonnecrotizing soft tissue infection and for planning the treatment of necrotizing fasciitis.

Anti-Infective Agents↗
PubMed1993

Dermal and intravascular fasciitis. Unusual variants of nodular fasciitis.

Three cases with characteristic features of nodular (pseudosarcomatous) fasciitis arising in the dermis are described. This is only the second report documenting a dermal location for this condition. One of the three cases also showed features of intravascular fasciitis. A fourth case of intravascular fasciitis arising in periocular tissue is included. The differential diagnosis of dermal fasciitis includes benign fibrous histiocytoma, pyogenic granuloma, peripheral nerve tumors, cutaneous smooth muscle tumours, spindle cell carcinoma, spindle cell melanoma, dermatofibrosarcoma protuberans and atypical fibroxanthoma.

Adolescent↗
PubMed1996

Borrelial fasciitis: diffuse fasciitis and peripheral eosinophilia associated with Borrelia infection.

We present four cases of diffuse fasciitis (DF) associated with peripheral eosinophilia in which spirochetal organisms were identified. Two patients had borderline positive results on serologic evaluation for Borrelia burgdorferi. Deep biopsy showed dermal sclerosis associated with variable degrees of perivascular mononuclear inflammation. Diffuse fasciitis, septal panniculitis, and myositis with mononuclear cell infiltrates and varying numbers of eosinophils were observed. All cases showed a striking lymphocytic vasculopathy associated with atypical reactive endothelial cells. Using modified Dieterle and Steiner silver stains, multiple organisms were seen in one specimen, a single unequivocal organism detected in two specimens. In one case, no organisms were detected on silver stain; however, organisms were demonstrated using rabbit polyclonal antibodies against B. burgdorferi. B. burgdorferi-specific DNA was identified in one patient by the polymerase chain reaction. These results indicate that some cases of eosinophilic fasciitis are an expression of Lyme disease. We have previously proposed the more specific term "borrelial fasciitis" to describe such lesions.

Adult↗
PubMed1991

Concurrent eosinophilic fasciitis and cutaneous T-cell lymphoma. Eosinophilic fasciitis as a paraneoplastic syndrome of T-cell malignant neoplasms?

Eosinophilic fasciitis has been reported to precede hematologic malignant neoplasms such as myelomonocytic leukemia, lymphocytic leukemia, and Hodgkin's lymphoma. In this case study, eosinophilic fasciitis occurred concurrently with cutaneous T-cell lymphoma (mycosis fungoides). The clinical diagnosis of eosinophilic fasciitis was based on painful sclerodermatous lesions on the extremities and trunk without acrosclerosis. There was histologic confirmation with edema and lymphocytic inflammation in the superficial muscular fascia and dermis. Deposition of immune reactants was found in the fascia and dermis. In addition, peripheral eosinophilia and circulating immune complexes were detected. The diagnosis of cutaneous T-cell lymphoma (mycosis fungoides) was based on extensive erythematous cutaneous plaques, dermal and epidermal lymphocytic atypia, loss of pan-T-cell immunologic markers, and a cutaneous lesional T-cell receptor beta-chain rearrangement by Southern blot analysis. Eosinophilic fasciitis may occur as a paraneoplastic syndrome associated with hematologic malignant neoplasms, including mycosis fungoides. Cytokines or lymphokines released by activated immunocytes, either malignant leukocytes or normal leukocytes reacting to malignant cells, may be responsible for the eosinophilia and sclerosis seen in these associated hematologic malignant neoplasms.

Aged↗
PubMed1988

Tartrate-resistant acid phosphatase containing cells in nodular fasciitis, proliferative fasciitis, and proliferative myositis.

Five cases of nodular fasciitis, three cases of proliferative fasciitis, and one case of proliferative myositis were investigated by tartrate-resistant acid phosphatase (TRAP) histochemistry on conventional paraffin-embedded material. In all cases varying numbers of enzyme-positive cells were detected. Cytological investigations revealed the presence of small round cells, elongated spindle cells, medium-sized mono- or binucleated cells, and multinuclear giant cells, the latter resembling osteoclasts. However, the typical ganglion-like cells were TRAP-negative in almost all tests. The TRAP-pattern may help to differentiate nodular fasciitis and allied lesions from inflammatory pseudotumours or organising haematomas, as the latter do not contain TRAP-positive cells. As TRAP appears to be a marker for a special population of phagocytizing and non phagocytizing histiocytes, nodular fasciitis and its proliferative variants may be assumed to be fibrohistiocytic tumorous conditions.

Acid Phosphatase↗
PubMed2004

A case of dermato-fasciitis: amyopathic dermatomyositis associated with fasciitis.

Amyopathic dermatomyositis (ADM) is characterized by the typical cutaneous features of dermatomyositis and minor involvement of the skeletal muscles. A 50-year-old woman had fever, reddening and pain in the distal part of all four limbs, and cutaneous findings such as Gottron's papules and periorbital heliotrope. She showed no muscle weakness or atrophy, and her serum creatine kinase was within the normal range. Electromyography showed no myopathic pattern. Magnetic resonance imaging (MRI) recorded abnormal hyperintensity in the fascia and muscle of the tibialis anterior. A biopsy from the tibialis anterior muscle showed fasciitis and mild myopathic changes with focal perivascular infiltration. This patient also presented with interstitial pneumonitis, although evaluation for malignancy was negative. With steroid therapy, her symptoms and MRI abnormality disappeared within 2 months. This case is therefore considered to be a variant of ADM, presenting as dermato-fasciitis.

Anti-Inflammatory Agents↗
PubMed1991

Flow cytometric study of nodular fasciitis, proliferative fasciitis, and proliferative myositis.

DNA ploidy was assessed retrospectively, using flow cytometry, in 13 nodular fasciitis (NF) lesions, three proliferative myositis (PM) lesions, one proliferative fasciitis lesion, and 12 other benign fibrous lesions (BFLs). All were diploid. In view of the large amounts of cellular debris, cell cycle analysis was possible in only seven NF lesions, three PM lesions, and six BFLs. The mean percentage of S phase did not differ markedly between the combination of NF and PM lesions (6.6%) and BFLs (7.1%); the mean percentage of G2 + M phase (5.4%) of the NF/PM lesion combination was twice as large as that of the BFLs (2.5%). No correlation was detected between the cell cycle analysis and the mitotic count, the predominant histologic type in NF lesions, or the predominant stroma in PM lesions.

DNA↗
PubMed1992

A histopathologic comparison of Shulman's syndrome (diffuse fasciitis with eosinophilia) and the fasciitis associated with the eosinophilia-myalgia syndrome.

A comparison of the histopathologic features of Shulman's syndrome (diffuse fasciitis with eosinophilia) and the fasciitis associated with the eosinophilia-myalgia syndrome is presented. The study population consisted of eight biopsy specimens of seven patients with Shulman's syndrome and 11 specimens from 10 patients with eosinophilia-myalgia syndrome. Both groups exhibited inflammatory changes in the subcutaneous fat, septa, and fascia; cutaneous changes were more prominent in cases of eosinophilia-myalgia syndrome. Eosinophils and plasma cells were not consistently present in either condition; mast cells and factor XIIIa-positive cells were consistently present in the inflammatory infiltrates. Although there was overlap in the histopathologic findings, Shulman's syndrome tends to involve the subcutis alone and the eosinophilia-myalgia syndrome tends to be a pancutaneous-subcutaneous process.

Eosinophilia↗
PubMed2002

Clonal rearrangement of 15p11.2, 16p11.2, and 16p13.3 in a case of nodular fasciitis: additional evidence favoring nodular fasciitis as a benign neoplasm and not a reactive tumefaction.

This article describes a case of nodular fasciitis with the karyotype 47,XY,+4/46,XY,add(15)(p11.2), t(16;16)(p13.3;p11.2). The presence of clonal chromosomal abnormalities in this case, as well as in three previously reported cases, indicates that nodular fasciitis is a benign neoplasm and not a reactive lesion.

Cell Transformation, Neoplastic↗
PubMedDate not supplied

[Necrotizing fasciitis of the head and neck. Report of 4 cases of cervical necrotizing fasciitis].

Necrotizing fasciitis is a severe polybacteria infection characterised by necrosis of the fascial and adjacent soft tissues with rapid expansion of the infection along fascial planes. It may originate potentially fatal complications and often is accompanied by systemic toxicity. It is not a frequent entity in the head and neck, but early diagnosis is very important because early treatment based on intravenous antibiotherapy and aggressive surgical debridement can prevent complications that often cause the death of the patient. Pour reports of necrotizing fasciitis are presented, one of them with fatal outcome, which leads us to emphasize the importance of an early diagnosis.

Aged↗
PubMed1977

Proliferative fasciitis. A variant of nodular fasciitis.

The clinical and pathologic features of eight cases of proliferative fasciitis, a variant of nodular fasciitis, were described. The lesion affected adults older than 51 years of age. It involved various parts of the body and grew rapidly in most cases. Follow-up information, however, revealed that the patients took a benign clinical course after a local excision. Microscopically a diffuse proliferation of fibroblastic cells intermingled with a number of large basophilic cells resembling ganglion cells was characteristic, and was accompanied by slight lymphocytic infiltration and by slight fibrinous exudation and hemorrhage. The large basophilic cells seemed to be metamorphosed from cells of fibroblastic series.

Aged↗
PubMed1989

Colitis and pericarditis in a patient with eosinophilic fasciitis. A contribution to the multisystem nature of eosinophilic fasciitis.

A case of eosinophilic fasciitis (EF), associated with monoclonal gammopathy, thyroglobulin antibodies, pericarditis and colitis, is described. The occurrence of EF in the framework of a multisystem disease is the outstanding feature, contrasting with the absence of visceral involvement or solitary organ involvement in the large majority of cases. The unusual histologic features of the colitis and beneficial effect of cimetidine on EF are discussed.

Aged↗
PubMed1984

[Fasciitis eosinophilica--transition to an unusual scleroderma (scleroderma-fasciitis)].

Eosionophilic fasciitis (EF) was observed in a girl who suddenly developed indurations of the limbs accompanied by hypergammaglobulinaemia and peripheral eosinophilia. The deep fascia was impressively thickened and infiltrated with numerous inflammatory cells showing focal accumulations of eosinophils. The disease was progressive in spite of application of corticosteroids, and within three years, symmetrical sclerodermatous lesions developed on the face and trunk, going along with a severe sclerodactyly without Raynaud's phenomenon, as well as contractures of the upper and lower limbs causing complete disability. Visceral involvement was slight (decreased motility of the esophagus and restriction of pulmonal function); slight calcium deposits were disclosed at the soft tissue of the ankles; and nuclear antibodies of the speckled type appeared in a titer up to 320. The fascia was still the most involved tissue, but there was no peripheral or tissue eosinophilia. EF seems to be a special variant within the broad spectrum of scleroderma; and although it usually has a benign course, it may change into an unclassified variety of scleroderma and lead to severe disability.

Adolescent↗
PubMed1980

Cranial fasciitis: nodular fasciitis of the head.

An infant was noted at birth to have a lesion over the left coronal suture fixed to both the skin and periosteum, which was identical histologically to nodular fasciitis. This lesion has been described in the literature in various locations, but rarely in the scalp, and not in newborns.

Female↗