Necrotizing Fasciitis Caused by Klebsiella pneumoniae in a Patient Undergoing Hemodialysis: A Case Report and Literature Review

Necrotizing fasciitis is not rare in clinical practice but a Klebsiella pneumoniae-related is rare, especially in patients undergoing hemodialysis. Many patients with necrotizing fasciitis have a miserable outcome even though they receive amputation.
A 76-year-old male was initially admitted to the center due to suspected cellulitis in Taichung, Taiwan. However, the treatment response was beyond expectation and a plain film X-ray was performed on his leg. To our surprise, it showed apparent gas and calciphylaxis. Easy examination detected the severe disease. Immediate surgical debridement was performed and his legs and life were successfully saved, although the outcomes of the disease were miserable. The tissue culture yielded Klebsiella pneumoniae. This pathogen, related to necrotizing fasciitis, is rare in the current published articles. The possible risk factors were endemic region, diabetes mellitus, calciphylaxis, old age, frequent iron supplements, and repeated tissue hypoperfusion during hemodialysis.
In conclusion, meticulously and timely diagnosed necrotizing fasciitis in high risk groups is the most important factor to ensure a positive patient outcome.