Early surgery for limb preservation in Group A Streptococcus-induced necrotizing soft tissue infection and subsequent soft tissue infection: A case report
Toshio Uchikura,
Nobuaki Mori,
Aki Kono,
Hiroshi Arino,
Takashi Takahashi,
Ichiro Takeuchi
Affiliations
Toshio Uchikura
Department of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
Nobuaki Mori
Department of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Corresponding author at: Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, Japan.
Aki Kono
Department of Orthopedics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Hiroshi Arino
Department of Orthopedics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Takashi Takahashi
Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan
Ichiro Takeuchi
Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
Background: Group A Streptococcus pyogenes (GAS) causes necrotizing soft tissue infections (NSTIs) necessitating exploration, surgical debridement, and possibly limb amputation. Case presentation: A 45-year-old man presented with traumatic injury of the left carpal region, vomiting, and diarrhea. The swelling and pain in the left forearm worsened with sensorimotor deficits, and his skin color deteriorated. Emergent exploration was performed for limb preservation; GAS was detected in an exudate, and debridement was performed on postoperative day 2 for streptococcal toxic shock syndrome. He recovered uneventfully and was discharged; however, he returned after 2 months with GAS-induced STI at the same site and received antimicrobial treatment. Conclusion: Exploration and subsequent debridement are crucial for effective treatment of NSTI.
