Necrotizing Soft Tissue Infection of Left Shoulder and Upper Limb Following Intravenous Injection of Non-steroidal Anti-inflammatory Drug

Abstract

Necrotizing soft tissue infection (NSTI) is a rapidly spreading and fulminant infection that may occur within any layer of skin and soft tissue and may result in sepsis and multiorgan failure. Cases of intravenous injection of drugs causing NSTIs have been reported, especially involving injection of illicit drugs or insulin. NSTI can be due to polymicrobial or monomicrobial infection and infection involving Klebsiella species has been rising, especially in patients with diabetes mellitus. This is a case of an extensive upper limb and shoulder Klebsiella pneumoniae NSTI following an injection of a non-steroidal anti-inflammatory drug in a diabetic patient. NSTI diagnosis is based on history and clinical examination, supplemented with imaging and laboratory investigations. Early recognition, extensive and serial debridement, antibiotics, and wound management are crucial for the better outcome of the disease. This patient underwent emergent debridement with antibiotics coverage, followed by serial debridement and wound care. The wound healed within the stipulated time, with good function of the affected limb following the rehabilitation program.