Major Amputation Needed to Treat Purulent Tenosynovitis and Necrotizing Fasciitis in a Patient with a Human Bite and Severe COVID-19

Abstract

Akira Toga,1,* Ayush Balaji,2,* Shigeki Nagura1 1Department of Orthopedic Surgery, Saiseikai Yokohama-shi Tobu Hospital, Yokohama, Kanagawa, Japan; 2Hull York Medical School, University of York, York, UK*These authors contributed equally to this workCorrespondence: Akira Toga, Department of Orthopedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan, Tel [phone], Fax [phone], Email [email protected]: Peripheral human bite wounds are rarely serious and are typically treated medically, with the most complex cases requiring only minor amputation or excision of the infected site. There are few to no reports documenting the development of purulent tenosynovitis, necrotizing fasciitis, and osteomyelitis from these lesions. Major amputations are required only rarely in these cases.Case Presentation: A 71-year-old woman presented with an uncontrolled infection following a self-inflicted bite wound to her left middle finger. A bacterial culture of the lesion revealed methicillin-resistant Staphylococcus aureus (MRSA). The infection could not be controlled with antibiotics or additional interventions, including debridement and minor amputation. She contracted severe COVID-19 while in the hospital which limited the available treatment options. In an attempt to control the infection, the patient ultimately underwent a major amputation of the distal left forearm. While recovering from the procedure, the patient succumbed to septic shock and cardiopulmonary arrest.Conclusion: The unusual progression of this case may be attributed to the interventions required to treat acute COVID-19 as well as a variety of confounding factors. For example, vasopressors and steroids used to treat severely-ill patients compromise the local and systemic physiologic responses to acute bacterial infection. It is important to reconsider clinical expectations during the pandemic and intervene as early as possible to prevent ongoing damage and clinical deterioration.Keywords: COVID-19, amputation, bite wound, necrotizing fasciitis, gangrene, purulent tenosynovitis, immunocompromised

Keywords

• covid-19
• amputation
• bite wound
• necrotizing fasciitis
• gangrene
• purulent tenosynovitis
• immunocompromised;