Work

Meleney's gangrene: A diagnostic pitfall in the context of lower lumbar hypoesthesia – A case study

Year: 2025

Type: article

Abstract: Meleney's gangrene is one of the conditions classified under necrotizing “soft tissue infections” . This uncommon illness has a high fatality rate and requires immediate diagnosis, aggressive antibiotic therapy, and extensive debridement. The mortality rate associated with Meleney's gangrene is approximately 34 %. Here we report the case of a 50-year-old immunocompetent woman, with no known comorbidities and no recent surgical history. She was initially diagnosed with a perineal abscess; however, after the infection worsened, she was later diagnosed with Meleney's synergistic gangrene. Immediate extensive debridement was performed, and empirical intravenous antibiotics were administered. Shortly after the procedure, and before regaining consciousness, the patient's condition rapidly deteriorated, and she succumbed to death. Early identification of Meleney's gangrene, followed by prompt treatment with broad-spectrum antibiotics and aggressive surgical debridement, is essential for improving outcomes. However, early diagnosis is often challenging, and considerable uncertainty may complicate the process. A delayed diagnosis of Meleney's gangrene significantly increases the risk of mortality. This case is reported to highlight how delayed diagnosis and late intervention can result in a fatal outcome in cases of Meleney's gangrene. Effective treatment can be implemented only if early diagnosis of this rare form of gangrene is achieved. • High Mortality Rate: Meleney's gangrene, also known as progressive bacterial synergistic gangrene, has a mortality rate that can be as high as 30-40%, and even higher (up to 90%) in patients with diabetes. • Delayed Diagnosis: The initial presentation of Meleney's gangrene often resembles cellulitis, making early diagnosis challenging. This delay in diagnosis significantly impacts mortality. • Importance of Early Aggressive Treatment: Prompt surgical debridement, combined with broad-spectrum antibiotic therapy, is essential for managing this infection and improving patient survival. • Role of Underlying Conditions: Meleney's gangrene is more common in patients with diabetes and those with compromised immune systems, highlighting the importance of managing these underlying conditions. • Rarity and Clinical Importance: While relatively rare, the rapid progression and severity of Meleney's gangrene necessitate its recognition and timely intervention. • Successful Outcomes with Aggressive Management: Case reports have shown that aggressive debridement, along with appropriate antibiotic therapy and supportive care, can lead to successful outcomes, even in severe case • Need for early intervention: Delay in intervention is life-threatening. Management is centered on a rapid and aggressive multidisciplinary approach.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.112004