Necrotizing Soft Tissue Infection or Sweet Syndrome: Surgery Versus No Surgery?

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Abstract

The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle—findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Evaluation of tissue samples by dermatopathology revealed neutrophilic infiltration extending into the dermis and muscle necrosis, findings consistent with necrotizing Sweet syndrome. The initiation of IV corticosteroids, the gold-standard treatment for necrotizing Sweet syndrome, lead to significant clinical improvement. When soft tissue infections do not respond to debridement and broad-spectrum antimicrobial coverage, perioperative care providers should consider necrotizing Sweet syndrome as an underlying cause. By facilitating the early diagnosis and appropriate management of unique conditions such as necrotizing Sweet syndrome, anesthesiologists can not only play a more visible role as leaders in the emerging perioperative surgical home model, but they may also prevent significant patient morbidity and reduce unnecessary utilization of health care resources.

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