PMC5733867_01
Marked swelling with discoloration of the dorsum of the left hand following cat bite.
CRICC2017-3718360.001.jpg
PMC5733867_01_CRICC2017-3718360.001.jpg
fig1
57-year-old female with history of rheumatoid arthritis on oral corticosteroid and methotrexate therapy was admitted to the hospital for the evaluation of painful swelling of the left hand (Figure 1).
After surgical excisional debridement of skin, subcutaneous tissue, and muscle of hand and forearm.
CRICC2017-3718360.002.jpg
PMC5733867_01_CRICC2017-3718360.002.jpg
fig2
Hand surgeon was consulted and she underwent immediate surgical excisional debridement of skin, subcutaneous tissue, and muscle of hand and forearm (Figure 2).
CT of chest showing bilateral infiltrates.
CRICC2017-3718360.003.jpg
PMC5733867_01_CRICC2017-3718360.003.jpg
fig3
In spite of all the adequate therapy for the necrotizing fasciitis, streptococcal toxic shock syndrome, and acute kidney injury, her hospital course was complicated by acute respiratory failure secondary to acute respiratory distress syndrome (Figure 3) and deep vein thrombosis with paradoxical embolism and cerebrovascular accident.