Pyo-adipocytolytic –Necrolysis Subcutis and Pan-necrotizing Subcutis: Unusual Dermato-Pathological Entities, Complications of Injection Abscess Given by Unskilled Personnels- Management and Outcome

Abstract

Injection abscess are becoming common complications seen in sub-Saharan Africa. The abscess may further become a root for unusual dermato-pathological clinical findings when they are not initially managed properly. Pyo-adipocytolytic-necrolysis subcutis and Pan-necrotizing subcutis were unusual subcutaneous pathologies that emanate from unsafe injections in the clinical reported cases seen in a child and a 3rd trimester pregnant woman. The terms describes the extensive complications arising from extension of injection abscess, as a result of inoculation of antibiotics low sensitive and resistant Staphylococcus sp and Proteus sp during intramuscular injections. Catalyst to the pathogenesis including lack of handwashing, lack of swabbing of injection site with antiseptics before procedure, poorly selected anatomical locations, reusing unclean disposable gloves. The retrospective review  revealed  some observational finding that affirm the pathological terms which can be used by clinicians to identify these entities such as adipocytolysis, abscess local invasiveness, distant metastasis of necrolysis and recurring  pathology from site of injection abscess, Pan-Adipo necrolysis of the subcutaneous layer. The presence of these entities usually occur on background of immunosuppression as in pregnancy and in severe acute malnutrition as seen in the reviewed  cases. Their prognosis is favorable when adequate and high quality nutrients are available, aseptic incision and drainage, highly sensitive and specific antibiotics, protocols for injection are duly followed and psychosocial support is available.