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Necrotising fasciitis — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesNecrotising fasciitisSCE Acute Medicine

A 57-year-old man with diabetes presents with rapidly worsening thigh pain after a minor abrasion. The skin is dusky with bullae, pain is severe beyond the visible erythema and he is hypotensive. CRP is 330 mg/L, sodium 128 mmol/L and lactate 4.9 mmol/L. What is the most appropriate next step in management?

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Correct answer: A — Immediate broad-spectrum antibiotics and urgent surgical exploration

Severe pain, systemic toxicity, bullae and hyponatraemia suggest necrotising fasciitis, requiring immediate antibiotics and surgical debridement. Imaging should not delay operative source control when clinical suspicion is high. Oral therapy is inadequate. The pearl is that necrotising infection is a surgical diagnosis with medical resuscitation running in parallel.

Reference: NICE CKS cellulitis; IDSA skin infection guidance