Leclercia Adecarboxylata and Lower Extremity Necrotizing Fasciitis

Leclercia adecarboxylata is a gram negative bacillus from the Enterobacteriaceae family, cultured as the main infective agent or within a polymicrobial environment, in both immunocompetent and immunosuppressed individuals. Necrotizing fasciitis (NF) is a devastating and sinister disease that can result in disfiguring wounds, amputations, and death. NF frequently requires large-scale debridements as the result of a breach in the host immunologic defenses from a variety of causes.

Many risk factors have been described, including diabetes mellitus, alcoholism, chronic kidney disease, liver cirrhosis, surgical wounds, and abrasions. NF is commonly a polymicrobial infection (type I) although mono-microbial (type II) infections may also take place. L. adecarboxylata is a rare organism in NF, which is more frequently caused by Staphylococcus aureus or Streptococcus variant. A week before seeking medical attention for a nonhealing wound, a 55-year-old male developed a lower extremity NF with a polymicrobial infection, which included Leclercia adecarboxylata.

On presentation, it was difficult to determine if he had a necrotizing soft tissue infection (NSTI) or NF. His calculated LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score was only three, which predicted a <50% chance of his wound being an NF. Left foot and tibia/fibula radiographs demonstrated subcutaneous air tracking along the dorsal aspect of the swollen foot consistent with NF. In this case, the delay in presentation, despite immediate surgical intervention, led to a spread of tissue necrosis requiring a below-the-knee amputation.

Necrotizing fasciitis is a surgical emergency, and a diagnosis made clinically. Once suspected, immediate operative debridement of all necrotic tissue is imperative to salvage the patient’s life and limb.