Postpartum and vulvar necrotizing fasciitis. Early clinical diagnosis and histopathologic correlation
Schorge, J.O.; Granter, S.R.; Lerner, L.H.; Feldman, S.
Journal of Reproductive Medicine 43(7): 586-590
1998
ISSN/ISBN: 0024-7758 PMID: 9693409 Document Number: 486842
OBJECTIVE: To review the clinical course and correlate histopathologic findings of obstetrics and gynecology patients with necrotizing fascitis. STUDY DESIGN: Seventeen patients with postpartum or vulvar necrotizing fascitis were identified from 1981 to 1996. Medical records were retrospectively reviewed. Information was available for all patients until death or discharge from the hospital. Histopathologic material on 15 patients was available for review. RESULTS: Five postpartum patients were diagnosed and surgically debrided one to nine days after cesarean delivery, with no mortality. Twelve patients with vulvar necrotizing fasciitis were diagnosed and surgically debrided <1-10 days after presentation to a physician, with three deaths (25%). On histopathologic review, all cases had prominent lobular and septal panniculitis. Thirteen cases had histological evidence of fasciitis. CONCLUSION: Early diagnosis and aggressive surgical debridement in patients with postpartum and vulvar necrotizing fasciitis may improve the outcome. Histopathologic findings are remarkably consistent and may help to confirm the diagnosis.