[SavageGlow]

We describe the case of a Caucasian 52-year-old woman, teacher, married. She was diagnosed with acute myeloid leukemia (AML) in January 2019, after presenting to the emergency department due to respiratory symptoms and fever. She was initially diagnosed with an acute respiratory tract infection, new-onset pancytopenia, and febrile neutropenia. After admission to the hematology inpatient unit for treatment and further investigation, a bone marrow aspirate and core biopsy revealed a hypercellularity with 42% myeloblasts, suggesting AML with maturation. Immunophenotyping showed 36.73% myeloblasts, CD34+, CD117+, and CD13+. Screening for gene rearrangements and mutations showed no recurrent mutation (FLT3, CEBPA, RUNX1, TP53 negative) and conventional cytogenetic analysis showed a normal karyotype.

[shelly80]

Whoa

[LittleNightmare]

Damn

[Hogmann]

I was more afraid to view this than you probably were to view the rock climbing guy

[ride]

Imagine picking at the scab and bringing yourself to orgasm.

Too graphic?

[Bastet]

Did you just hear that screeching noise? It was my pussy crying out in sympathy pain

[Spiritual]

That’s nasty as hell, and that doesn’t look like a Caucasian woman, looks like a Indian or Hispanic or a black woman. Caucasians aren’t that dark and they don’t get such dark scar tissue. That’s besides the point but this looks like it hurt.

[kellyhound]

Originally Posted by Spiritual ↗

That’s nasty as hell, and that doesn’t look like a Caucasian woman, looks like a Indian or Hispanic or a black woman. Caucasians aren’t that dark and they don’t get such dark scar tissue. That’s besides the point but this looks like it hurt.

She's portuguese.

this is the first published case of a necrotizing fasciitis of carbapenemase-producing Klebsiella pneumoniae (CPKP) in a patient with acute myeloid leukemia.

Necrotizing fasciitis of the perineum is a rare, life-threatening, fulminant infection. Although the patient in this clinical case was a middle-aged woman, this condition is more common in elderly men.

Many comorbidities have been associated with this infection, namely diabetes, chronic alcohol use, malignancy, morbid obesity, cardiovascular disorders, long-term corticosteroid treatment, and human immunodeficiency virus infection.

All of these conditions have in common an immunosuppressive state that allows spreading of local bacteria into the perineal facial planes causing extensive tissue necrosis. It has been postulated that most of the bacteria originate from the urinary tract or from local intraabdominal or perineal infections such as abscesses, fistula, or vascular occlusions.

The approach to these patients includes immediate diagnosis, appropriate broad-spectrum antibiotics, and extensive surgical debridement to reduce mortality and morbidity, and to achieve local infection control.

Delay in the diagnosis of Fournier gangrene leads to an extremely high death rate owing to rapid progression of the disease, leading to sepsis, multiple organ failure, and disseminated intravascular coagulation.

In this clinical case, the patient was profoundly neutropenic, which provided increased susceptibility for the development of the infection, but neutropenia probably also protected the patient from the intensive neutrophilic infiltration of the tissues that is characteristic of Fournier gangrene.

We might hypothesize that this protected the patient from further tissue necrosis and provided more time for surgical intervention on removal of the necrotic tissue.

The microorganisms causative of necrotizing fasciitis are considered virulent strains that promote the rapid spread of the disease in an immunocompromised host.

Enterobacteriaceae belongs to this virulent species, together with Streptococcal, Staphylococcal, anaerobic organisms, and fungi. This one microorganism might produce the enzymes necessary to cause coagulation of the nutrient vessels, reducing local blood supply and, thus, tissue oxygen tension falls. The resultant tissue hypoxia allows for the growth of facultative anaerobes and microaerophilic organisms that can digest fascial barriers, fueling the rapid extension of the infection.

Because several microorganisms are responsible for the pathology of disease, broad-spectrum antibiotics are necessary for local infection control, but without surgical removal of necrotic tissue it is not possible to treat the infection because the antibiotic does not reach the infected areas. Hematologic malignancies are a comorbid condition that can increase susceptibility for the development of necrotizing fasciitis due to the immunosuppressive state of the host.

carbapenem-resistant Enterobacteriaceae are scary as hell.

How it started.

[WonderMomma]

Kim... your posts are beginning to make me feel I need to prep before I open them... like Herman's...

Make sure I am not eating and mentally prepare myself for what I'm going to see.

[SavageGlow]

Originally Posted by Hogmann ↗

I was more afraid to view this than you probably were to view the rock climbing guy

I had someone else watch if for me and tell me what happened. I'm going to give that one a hard pass.