730 - Four Limb Amputation Secondary to Necrotizing Fasciitis in a SLE Immunocompromised Patient

Case Diagnosis: Bilateral Transradial and Bilateral Transtibial Amputation secondary to Necrotizing Fascitis in a SLE Immunocompromised Patient

Case Description: The patient is a 20 y/o female who presented to ED with blistering/swelling of the left arm and shortness of breath for two days. Overnight, the patient developed septic shock, acute renal failure, rhabdomyolysis, and metabolic acidosis. Additionally, the swelling had spread to all four limbs. She required multiple vasopressors and was taken to the OR for fasciotomies for all four extremities. Unfortunately, she developed necrotizing fasciitis and limb ischemia in all four limbs. Her limbs became mottled and unviable. The patient was critically ill and it was recommended that she have a four limb amputation which she eventually underwent.

Discussions: Initially, the patient had refused amputations of her four limbs and unfortunately, the limb ischemia was spreading to more proximal parts of her extremities. After a couple of weeks of refusing, Physiatry was consulted to assist with educating the patient about life after amputation including recovery, rehabilitation, and prosthesis. We visited and spoke with the patient and family multiple times including bringing a three-limb amputee peer support person to come to speak with them as well. Having the amputee peer support come speak with the patient really made a difference and eventually, the patient made the difficult decision to proceed with the four-limb amputation which ultimately saved her life by stopping the spread of infection/ischemia.

Conclusions: Early consultation with physiatry in the acute hospital setting plays a key role in patients who are being considered for amputations. Life after amputation is an unknown topic for most healthcare professionals and patients. Therefore, it is vital that physiatry be consulted to assist with education and preparation for post-amputation recovery, rehabilitation, and prosthesis planning.