"It's difficult to diagnose necrotizing fasciitis, because in the early stages, the signs and symptoms tend to be very wide, very general, very easily confused with minor diseases and minor conditions," said study researcher Dr. Ilaria Tocco Tussardi of the Institute of Plastic Surgery at University Hospital of Padova in Italy.
Tussardi and her colleagues were part of the team that treated the man who first sought medical attention for fever and a severe back pain. The man's former doctors had prescribed him strong pain killers for the pain, but the fever continued and his right buttock became red and inflamed.
Within six hours, the man's arm became red and swollen. He was transferred to the emergency room where doctors conducted a computed tomography (CT) scan and found his connective tissue had thickened. Doctors also found gas bubbles in his gluteus muscle prompting them to suspect he had a necrotizing fasciitis infection.
A Streptococcus bacteria, necrotizing fasciitis destroys soft tissue. There was no indication of how the Streptococcus bacteria got into the man's body, though it usually enters organisms through blisters or small cuts. The man had no history of either, and had two sites of infection.
Doctors suspect the bacteria managed to break into the bloodstream from one infection site and spread to the other. Researchers said there have only been 33 such cases reported in the past 50 years.
The man was already in critical condition and had trouble breathing when he arrived at the hospital, a sign of septic infection. Surgeons attempted to remove infected tissue, but their efforts were unsuccessful. Though the infection subsided, his arm had to be amputated and the septic shock compromised his heart.
He slipped into a coma and is currently in a residential facility for permanent coma patients. Doctors believe part of the problem was that the infection was diagnosed way too late.
"Usually, the physician who is seeing a patient with signs that might be compatible with necrotizing fasciitis doesn't usually think about it as the first diagnostic option," Tocco said.