Table 1.
Initial clinical presentation and investigations for Cases 1–5
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | |
|---|---|---|---|---|---|
| Clinical Presentation | Lower limb | Abdominal Wall | |||
| Age (years) and gender (male/female) | 62 M | 75 M | 70F | 60 M | 51 M |
| Location of NF | Left lower limb | Left lower limb | Abdominal wall | Abdominal wall | Abdominal wall |
| Duration of symptoms prior to presentation | 2 weeks | 5 days | 3 weeks | 2 weeks | 4 days |
| Previous GP/ED presentation symptoms? | Yes (GP) | Yes (GP) | Yes (ED) | Yes (GP/ED) | Yes (GP) |
| Features of sepsis on arrival to ED? (yes/no) | No | No | Yes | No | No |
| History of T2DM? (Hba1C) | Yes (10.3) | Yes (8.3) | Yes (unknown) | Yes (10.3) | Yes (10.8) |
| History of obesity? (weight) | Yes (114 kg) | Yes (108 kg) | Yes (112 kg) | No | Yes (136 kg) |
| LRINEC scorea | 4 | 9 | 8 | 1 | 1 |
| Initial pathology | |||||
| WCC (neutrophils) | 24.2 (21.0) | 19.7 (18.3) | 17.3 (14.3) | 10 (7.8) | 7.0 (4.5) |
| CRP | 96.9 | 382 | 489.9 | 89.6 | 22 |
| Lactate on admission | 3.8 | 1.9 | 9.9 | 1.0 | 1.0 |
| Radiological investigation | |||||
| Type of radiological investigation | CT left lower leg | X-ray left foot | CT abdomen/pelvis | CT abdomen/pelvis | CT abdomen/pelvis |
| Key imaging result | OM of great toe, extensive oedema and fat stranding to mid femur with subcutaneous gas to mid-tibia. | Subcutaneous gas within the subcutaneous soft tissues of the midfoot with marked soft tissue swelling. | Large volume abdominal wall fluid collection associated with extensive gas content. | Diffuse inflammation of the abdominal wall with gas in fascial planes and superficial skin ulceration. | Fat stranding of skin and superficial fascia with gas locules extending to base of the scrotum. |
aLaboratory Risk Indicator for Necrotising Fasciitis (LRINEC) [12]