A 70-year-old diabetic man presents with a 3-day history of swollen, erythematous, oedematous scrotum with foul-smelling discharge. CT shows scrotal gas with fascial plane extension to the perineum. Haemodynamically unstable. The LRINEC score concept is applied to risk-stratify suspected necrotising fasciitis. Which of the following C-reactive protein levels in isolation most reliably predicts necrotising fasciitis according to the LRINEC score?
- A CRP >50 mg/L
- B CRP >100 mg/L
- C CRP >150 mg/L ✓
- D CRP >200 mg/L
Explanation
The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score assigns 4 points for CRP >150 mg/L, making it the single highest-scoring variable in the index. A total LRINEC score ≥6 indicates intermediate-to-high probability of necrotising fasciitis. Other variables include WBC, haemoglobin, sodium, creatinine, and blood glucose. This patient has Fournier's gangrene (perineal necrotising fasciitis), a urological emergency requiring immediate resuscitation, broad-spectrum antibiotics, and radical surgical debridement. The CT finding of gas in the fascial planes is pathognomonic and mandates surgery regardless of LRINEC score.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.