Journal of Pediatric Surgery Case Reports (Mar 2023)
Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report
Abstract
Introduction: Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection caused by fulminant tissue destruction with severe systemic toxicity and a high rate of mortality. It often holds a diagnostic challenge as initially the overlying tissue might appear unaffected. Early surgical intervention parallel with antibiotic therapy forms the basis of appropriate treatment. We present a case admitted with a suspicion of severe allergic reaction due to an insect bite, but finally diagnosed with a NF. Case report: A 17-year old female with swelling, pain and erythema of the left hand was admitted to Heim Pál National Pediatric Institute, Budapest, Hungary on 07.08.2022. She had an insect sting on the same localization one day prior admission. Due to tachycardia and low blood pressure on admission, she was initially mistreated as a severe allergic reaction (anaphylaxis). Laboratory parameters showed elevated inflammatory reaction. Examination of the dorsal area of the left hand revealed swelling and edema with pallor on the fingertips. At the center of the insect bite a pinhead size of a bluish area was seen with one pinhead size of a bulla. Broad spectrum antibiotics (ceftriaxone) was initially started, but sepsis progressed since tachycardia and hypotension persisted. On the second day of hospital stay imaging diagnostics (ultrasound and magnetic resonance imaging) were taken which revealed the signs of NF. High dose penicillin and clindamycin were started and surgical debridement of all necrotic tissues was done. Blood cultures as well as swab culture grew Streptococcus pyogenes. After 4 days of antibiotic treatment and surgical intervention, general condition and symptoms showed rapid improvement. She received 10 days of antibiotic treatment total. Conclusion: This case demonstrates that early diagnosis of NF is crucial. Immediate surgical intervention is needed, regardless of the imaging findings as the delay in surgical intervention can have a great impact on mortality.
