Necrotizing Fasciitis and Myonecrosis of Both Legs due to Aeromonas: Two-Case Report

Abstract

Introduction: Aeromonas is a facultative, anaerobic Gram-negative bacillus. It has been reported that this bacterium is responsible for opportunistic infections in patients with compromised immune function due to an underlying disease. The infection usually occurs in one leg and following direct wound contact with water. These two reported cases had necrotizing fasciitis and myonecrosis of both legs without history of trauma but they presented with septicemia.

Case report;

Case 1: A 63-year-old man presented with severe right leg pain, fever and septic shock for 1 day. His underlying diseases included diabetes mellitus, hypertension and aplastic anemia. Right leg was markedly swollen with ecchymosis. X-ray demonstrated air in the muscle and subcutaneous fat. The diagnosis was gas gangrene and right AK amputation was performed. At post-operative day 1 his left leg became red, swollen and painful similar to the right leg. The patient did not want to have his left leg amputated. Wide debridement and fasciotomy were performed. Tissue culture revealed Aeromonas hydrophilla. With fever and progressive myonecrosis of the left leg, left AK amputation was then performed on post-operative day 11 with an uneventful recovery.

Case 2: A 47-year-old man presented with pain of both legs for 2 days, more on the left leg, and septic shock. Underlying diseases included diabetes mellitus, hepatitis C and cirrhosis. Ultrasound and X-ray of both legs showed no evidence of deep vein thrombosis or air in both legs. Debridement and fasciotomy were performed in both legs. Hemoculture and tissue culture revealed Aeromonas sobria. With daily open dressing, he had an uneventful recovery.

Conclusions: Necrotizing fasciitis and myonecrosis of both legs due to Aeromonas are not common and they result in high morbidity and mortality. Early and aggressive surgical intervention should be implemented.