[Necrotizing fasciitis complicating insulin-dependent diabetes: two cases]

Necrotizing fasciitis (NF) is a severe infection of the muscular fascia suggested by symptoms of cellulitis. A study of 2 cases of NF occurring in two insulin-dependent diabetic patients is reported in this article. At the clinical level the diabetes continued to be poorly controlled with cutaneous ketoacidotic decompensation. Inflammatory symptoms in the lower limb in one case and edema in the upper limb in the other led to confirmation of the diagnosis of NF by sonography of the soft tissue which showed fine subcutaneous collection with thickening of the fascia. The responsible microorganism isolated was a staphylococcus whose only possible point of entry is one of the points of injection of insulin due to a septic procedure. Therapeutic treatment includes medical treatment which consists of hydroelectrolytic restoration prevention of septic shock and tetanus. Antibiotic treatment administered according to the causal agent in some cases corrected on receipt of bacteriological results represents one of the foundations of medical treatment. Surgical treatment involving emergency surgery should be performed early with excision of the infected necrotic tissue. For the cases studied the postsurgical period was favorable and marked by an improvement in the general condition; diabetes was brought under control with insulin therapy at doses equivalent to those prior to the ketoacidosis. According to the authors severe infections of the soft tissues are medical-surgical emergencies whose diagnosis is sometimes difficult and is refined with sonography and which require in addition to medical treatment recourse to excision of the necrotic tissue.