Necrotizing fasciitis in two children with acute lymphoblastic leukemia.
Necrotizing fasciitis is a severe, soft tissue infection, and is an unusual condition in children. The cornerstone of therapy is prompt, aggressive surgical treatment. Despite vigorous treatment, mortality rates are high. We report the occurrence of necrotizing fasciitis in two children during the granulocytopenic phase of induction chemotherapy for acute lymphoblastic leukemia. The diagnosis and treatment of necrotizing fasciitis in these two children was made more difficult by their underlying disease and its chemotherapy. The successful treatment of their infections relied on a multimodality approach. Aggressive surgical debridement was the mainstay of therapy. Adjuvant therapy was vital to the successful outcomes and included meticulous wound care, intravenous hyperalimentation, appropriate antibiotics, and granulocyte transfusions.
Duncan
B W
BW
Department of Pediatric Surgery, University of California, San Francisco.
Adzick
N S
NS
deLorimier
A A
AA
Longaker
M T
MT
Ferrell
L D
LD
Zoger
S
S
Harrison
M R
MR
D000380:Agranulocytosis / Q000139:chemically induced / Q000150:complications* / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005208:Fasciitis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008161:Lumbosacral Region / Q000473:pathology; D009336:Necrosis; D009894:Opportunistic Infections / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D010502:Perineum / Q000473:pathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D011552:Pseudomonas Infections / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014847:Vulvitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy