Gout complicated with necrotizing fasciitis - Report of 15 cases

Objective. To analyse the clinical features and outcomes of gout complicated with necrotizing fasciitis. Methods. From the database of our hospital, we identified 15 hospitalized cases of gout complicated with necrotizing fasciitis from 1987 to 2001. The medical records of the patients were analysed in detail. Results. Mean patient age was 54.7 ± 12.8 yr. Fever was found in only 10 (66.7%) patients, while the remaining five patients were afebrile on presentation. The peripheral blood white count was raised in only nine (60%) patients. The median time from the onset of symptoms to hospital visit was 4 days (range 2 to 25). Formation of bullae occurred in 60% of patients. Six patients had previous wound infection, two patients had concomitant septic arthritis and the remaining seven patients had no obvious source of infection. Diabetes mellitus and iatrogenic Cushing syndrome were each found in three patients. The identified causative microorganisms were Gram-positive cocci (eight cases) and Gram-negative bacilli (four cases); but in three patients the causative organisms were unknown. Thirteen patients received surgery, including amputation in four cases. Finally, six patients suffered septic shock, three of whom died as a result. Conclusions. Necrotizing fasciitis in gout patients represents a surgical and medical emergency, and is associated with a high mortality rate. Prompt diagnosis and treatment is imperative and may be lifesaving. Early diagnosis requires a high level of suspicion, even in patients without fever or leucocytosis.