Bacterial Infection Leads to Amputation

Case Overview

This case takes place in Mississippi and involves a female patient who was admitted to hospital with complaints of an elevated fever. She had severe swelling and pain in her left hand. While in the waiting room, she informed the nurses about a painful wound on her left hand. The patient was informed that there was no one available at that time who could see to her hand. By the following day, the patient’s hand had begin to turn purple, and the discoloration spread over the course of the day. At some point that day, an infectious disease physician was called in on a consult, and noted that a wound care consult ought to be obtained but despite this recommendation, no consult was arranged. The following day the patient’s arm was odorous and black. The attending physician noted a strong foul odor to the area consistent with infection. Some days later the patient underwent an amputation of her left hand and forearm above the elbow.

Questions to the Infectious Disease and Communicable Disease expert and their responses

Do you routinely treat patients like the one described in this case?

I routinely treat patients with this condition.

What is the standard management of patients with this presentation?

The patient's elevated white blood cell count, if new, was a critical value in and of itself a likely reason for hospitalization. Depending on the appearance of the hand, urgent surgical consultation was warranted plus possibly an evaluation for vascular sufficiency.

Based on the brief summary of the case do you believe that this patient might have had a better outcome had the care rendered been different?

I would need to review the medical records to opine as to whether or not prompt appropriate care would have rendered her foot salvageable, however from the information provided it seems clear that the patient's care was mismanaged in this case.

Have you ever reviewed a similar case in the past?

I have reviewed similar cases and would be happy to review this case.

About the expert

This board certified expert has 27+ years of experience in the field of Infectious Diseases and has made the 'Best Doctors in America' list every year for almost 10 years. He is a Fellow of the American College of Physicians, The Society for Healthcare Epidemiology of America, and the Infectious Disease Society of America. He currently serves as the Director of the Division of Infectious Diseases at a large University-affiliated medical center, and the Director of the Fellowship program in Infectious Diseases at the same academic institution, he is also the Hospital Epidemiologist at a major hospital.