Candida albicans necrotizing fasciitis following cosmetic tourism: A case report

Lethal soft-tissue necrosis early after organ transplantation: a case report

Introduction and importance

Necrotizing soft tissue infection (NSTI) is a rapidly spreading infection which affects subcutaneous tissue, extending to a muscular level. Early and aggressive surgical exploration is frequently necessary, especially in patients with significant comorbidities or advanced age. NSTIs are commonly caused by Streptococcus pyogenes or methicillin resistant Staphylococcus aureus, though monomicrobial infections with Candida species have been reported.

Case presentation

A 64-year-old developed an NSTI of the upper left leg following bilateral lung transplantation. The patient presented with atypical clinical and radiographical symptoms, leading to initial management with antimicrobial therapy. Cultures taken preoperatively and intraoperatively were positive for Candida albicans without the presence of other microorganisms. Surgical exploration revealed extensive necrosis of the upper left leg and groin, resulting in deep sepsis which ultimately led to the patient's death.

Clinical discussion

NSTI should be monitored with extra vigilance in immunocompromised or otherwise at risk patients, especially when exhibiting atypical symptoms or disease course. Extensive surgical exploration remains the cornerstone of adequate treatment.

Conclusion

NSTIs caused by monomicrobial infections with C. albicans are rare and typically progress rapidly. We report a case of monomicrobial NSTI in an immunocompromised patient following bilateral lung transplantation characterized by atypical presentation and course, with C. albicans as the main pathogen.

Extracapsular breast implant rupture with silicone migration and lymphadenopathy following a breast augmentation - A case report

Silicone lymphadenopathy and granuloma formation can result from breast implants. A 71-year-old presented with implant rupture 30 years after a breast augmentation, causing left-sided silicone lymphadenopathy and extensive migration to the breast parenchyma and skin. Management included a mastectomy, lymph node resection, implant removal with complete intact capsulectomy, and latissimus-dorsi-based reconstruction.

Polymicrobial necrotizing fasciitis after a primary cesarean section in a low-risk patient: A case report and literature review

INTRODUCTION AND IMPORTANCE

Necrotizing fasciitis (NF) is a rare life-threatening soft tissue infection, with only few obstetrical cases reported in the literature.

CASE PRESENTATION

We report a case of a previously healthy female who developed polymicrobial NF on day 4 post an uncomplicated primary cesarean delivery, who presented initially with fever, chills, and abdominal pain.

CLINICAL DISCUSSION

The patient underwent a life-saving debridement of surgical wound with subsequent positive wound culture with polymicrobial growth and pathology suggestive of necrotizing fasciitis. Patient recovered in the intensive care unit with smooth postoperative course.

CONCLUSION

Early diagnosis and presumed aggressive intervention with early surgical debridement and supportive therapy were key factors favoring the good prognosis seen in this patient.

Unveiling the True Price: Assessing the Economic Impact of Cosmetic Surgery Tourism on a Single Tertiary Center in Bahrain

Background

In light of the escalating cost of cosmetic surgery in Bahrain, the burgeoning "Cosmetic Surgery Tourism" sector has captured the attention of many Bahrainis. Neighboring countries aggressively promote affordable packages on numerous social media platforms, luring individuals with the allure of a vacation experience. However, insufficient postoperative care abroad has far-reaching implications that jeopardize both patient well-being and the integrity of the healthcare system.

Objectives

This study aims to assess the present patterns of complications related to cosmetic surgery tourism and the resulting financial burden on the Bahraini healthcare system.

Methods

A retrospective cost analysis and chart review were performed for all patients who presented with complaints associated with cosmetic surgeries between January 2018 and September 2023. After identifying patient demographics, procedure characteristics, admission data, length of stay, and intervention needs, a comprehensive cost analysis was conducted.

Results

A total of 30 patients manifested complications. The complications associated with abdominoplasty were the most prevalent. Iran emerged as the most frequented destination, with Egypt and Turkey following in order of prevalence. Surgical-site infections constituted the most common complications. Required interventions included admission for intravenous antibiotics, hyperbaric wound care, implant removal, and critical care admission. The projected expense to the hospital was 65,970 BHD (175,000 USD), equating to an average expenditure of 2200 BHD (5852 USD) per patient.

Conclusions

The allure of cost-effective cosmetic treatments often leads to complications that impose substantial economic burdens. The study concludes with policy recommendations to balance individuals' freedom to seek healthcare abroad with long-term sustainability and equitable access to Bahrain's healthcare system.

Level of Evidence 5 Risk

Challenges with medical tourism

PURPOSE OF REVIEW

With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months.

RECENT FINDINGS

There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years.

SUMMARY

Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.

Reverse abdominoplasty as a salvage procedure for infected bilateral implant-based breast reconstruction

INTRODUCTION

Infection is one of the most feared complications of implant-based breast reconstruction and is difficult to manage in irradiated patients. We present the first case of bilateral breast reconstruction with infected expanders salvaged by performing a reverse abdominoplasty.

PRESENTATION OF CASE

A 64-year-old woman with a history of locally advanced bilateral breast cancer underwent modified bilateral radical mastectomy and postmastectomy radiotherapy. We performed two-stage breast reconstruction with implants. However, the patient developed a mild infection of the expanders, which was treated with targeted oral antibiotic therapy. The response to treatment was favorable, allowing us to salvage the reconstruction with a reverse abdominoplasty.

DISCUSSION

Traditionally, the management of infected breast prostheses has consisted of removal of the infected implant, a complication that forces a delay in the reconstructive process. Successful reports of salvage of infected prostheses have been described in the literature. On the other hand, we were able to salvage the reconstruction by performing a reverse abdominoplasty, which allowed us to resect the irradiated tissue and provide adequate non-irradiated soft tissue coverage for the replaced implants.

CONCLUSION

Reverse abdominoplasty offers an acceptable aesthetic result with much less donor site morbidity and represents a valid alternative to other complex reconstruction techniques.