Necrotizing Fasciitis? A Mimic Produced by an Unusual Presentation of Necrotizing Neutrophilic Dermatosis of the Hand: A Case Report.

CASE: A 50-year-old woman presented to our emergency department with hand pain and a laceration. Despite administration of antibiotics, the patient progressively worsened leading to a concern for a necrotizing soft-tissue infection. She underwent multiple debridements yet continued to worsen clinically. Tissue biopsy was eventually consistent with a necrotizing neutrophilic dermatosis. The patient was then started on oral steroids with rapid improvement of her clinical status and hand examination.

CONCLUSION

While neutrophilic dermatoses are rare, the orthopaedic surgeon treating soft-tissue infections should maintain a broad differential when treatment of a potential necrotizing infection has not led to diagnostic closure and clinical improvement.