A case of necrotizing fasciitis with a LRINEC score of zero: clinical suspicion should trump scoring systems

Michael P Wilson, Aaron B Schneir
Journal of Emergency Medicine 2013, 44 (5): 928-31

BACKGROUND: Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis.

OBJECTIVES: The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed.

CASE REPORT: A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery.

CONCLUSIONS: Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score.

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