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Extremely rare case of Necrotizing fasciitis (flesh-eating disease)⚠️

This 59 year-old woman was suffering from a very rare disease which has deprived her of the left half of her face, including the left eye and the left ear. The facial muscles have decayed and the left part of the lips also have been decayed exposing her teeth.
Until that day she had been leading a very normal life and had been a healthy lady who worked in order to meet her day to day expenses.

On that fateful day this dreaded disease commenced, she had fainted, subsequently showing symptoms of paralysis. The neighbours have rushed her to the hospital. They could not control the vomiting of the patient. The next day a swelling has developed in the left side of her face, and the following day the entire left area of her face became red. After two days the swelling started subsiding and simultaneously the muscles of the left side of the face started decaying. The left eye and the left ear had started shrinking appearing similar to dried leaves. After keeping her for two months, doctors operated and removed the accumulated pus content and also the left eye and the left ear. She was discharged after a total of three months.

Necrotizing fasciitis, known as flesh-eating disease, is an infection that results in the death of parts of the body's soft tissue.
It is a severe, rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues.

Typically the infection enters the body through a break in the skin such as a cut or burn.

Unlike cellulitis, necrotizing fasciitis involves the deeper layers of tissue down to the deep fascia and it is caused by anaerobic bacteria or group A streptococci.

Clinical manifestations include fever with an area of erythema.
Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting.

If not treated, the tissue begins to turn gray/black. It spreads quickly and aggressively from the primary infected area and beyond and can result in amputation, shock, and death if not treated by a combination of surgical exploration and debridement (removing the dead tissue) with IV antibiotics.


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This is a huge squamous cell carcinoma (T4) in the head, grown over 5 years until this patient sought help.
He was treated initially with a huge Orticochea Multi-Flap and after sent for chemo and radiation therapy.

Cutaneous squamous cell carcinoma (SCC) represents 20 % of all non-melanoma skin cancer and is a deadly threat owing to its ability to metastasize to any organ in the body.
High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple SCC tumors, and immunosuppression.
Metastatic SCC has a mortality rate of >70 %. Treatment options include surgery, radiation therapy, chemotherapy (cisplatin), and any combination of the above.
Surgery alone can be used for metastatic of high-risk SCC treatment but is not as effective as surgery in conjunction with radiation therapy. NCCN guidelines recommend 4-to 6-mm clinical margins for standard excision of low-risk SCC and 6 to 10mm in high-risk, like in this case.

In this patient, the resection was made with a 10mm margin, the resection was full-thickness (up to the periosteum), and in the central part, the outer table of the skull was resected. To cover this defect, a big Orticochea flap was made. The Orticochea flap is an excellent option for scalp reconstruction as it decreases operative time may provide hair-bearing skin. After the surgery, the patient was sent to receive chemo and radiation.


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Purple Urine! A 76-year-old male nursing home resident with dementia and end-stage renal disease who was undergoing hemodialysis was admitted to the hospital after a syncopal episode that occurred during dialysis. Torsades de pointes was noted on telemetry monitoring.

When a urinary catheter was placed, purple urine was drained. The patient had no fever, lower urinary tract symptoms, or leukocytosis.

The urinalysis showed a pH of 9.0 and bacteriuria but no hematuria or pyuria.

The urine culture showed 105 colony-forming units or more per milliliter for both Pseudomonas aeruginosa and enterococcus species.

Over the next 3 days, the urine gradually became yellow and clear, in the absence of antibiotic treatment.

Purple discoloration can occur in alkaline urine as a result of the degradation of indoxyl sulfate (indican), a metabolite of dietary tryptophan, into indigo (which is blue) and indirubin (which is red) by bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species.

The clinical course is benign, and the urine typically clears with resolution of the bacteriuria and acidification of the urine.
This patient had no further episodes of torsades de pointes.


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