Enterobacter cloacae-Related Necrotizing Fasciitis After Peritoneal Dialysis in Delayed Graft Function: A Case Report.

INTRODUCTION: Necrotizing fasciitis is an uncommon soft-tissue infection that involves the superficial fascia, subcutaneous fat, and deep fascia. Herein, we report the first case of Enterobacter cloacae-related necrotizing fasciitis after peritoneal dialysis in delayed graft function. CASE: A 58-year-old man, who was a hepatitis B-viral carrier and had atrial fibrillation, received cadaveric renal transplantation with peritoneal dialysis and encountered delayed graft function. On postoperative day 5, we tried hemodialysis via the right jugular dialysis catheter. However, he was unable to endure the hemodynamic changes during hemodialysis, showing rapid ventricular rhythm on electrocardiography. On postoperative day 7, we changed to peritoneal dialysis. However, he presented with fever and pain on his left flank and lower extremity. His white blood cell count and C-reactive protein levels were suddenly elevated. According to the abdomen computed tomography scan, there were subcutaneous fluid and air in the left flank and anterolateral pelvic wall. We performed peritoneal dialysis catheter removal, debridement, and drainage of the left external oblique muscle fascia. In a culture, Enterobacter cloacae was identified. After receiving meropenem for 2 months, his wound healed and delayed graft function was recovered.
CONCLUSION: Peritoneal dialysis of delayed graft function seems to be effective in reducing the incidence and severity of delayed recovery of renal function after renal transplantation in some reports. However, it is necessary to be cautious when dealing with a rapidly developing and life-threatening soft-tissue infection, such as necrotizing fasciitis. To reduce mortality rates, early diagnosis, recurrent surgical debridement, and aggressive therapy are mandatory.