title: Toxic shock syndrome and necrotizing fasciitis complicating neglected sacrococcygeal pilonidal sinus disease: report of a case.
abstract: OBJECTIVE
  This study was conducted to report the rare combination of necrotizing fasciitis and toxic shock syndrome, which both complicated neglected sacrococcygeal pilonidal sinus disease.
  
  
  METHODS
  A case report is presented.
  
  
  RESULTS
  We describe the rare case of a previously healthy adult male patient who developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis. Patient's response to emergency surgery followed by repeated debridements of necrotic tissue, together with aggressive fluid resuscitation, broad-spectrum antibiotic coverage, and hyperbaric oxygenation was good.
  
  
  CONCLUSIONS
  This case serves again as a clear reminder that neglected pilonidal sinus disease can lead to unusual and life-threatening consequences.
authors.affiliation: Department of Emergency Surgery, Military Medical Academy, Sofia, Bulgaria.
authors.forename: N
authors.initials: N
authors.lastname: Velitchkov
authors.forename: M
authors.initials: M
authors.lastname: Djedjev
authors.forename: G
authors.initials: G
authors.lastname: Kirov
authors.forename: J
authors.initials: J
authors.lastname: Losanoff
authors.forename: K
authors.initials: K
authors.lastname: Kjossev
authors.forename: H
authors.initials: H
authors.lastname: Losanoff
mesh_terms: D001442:Bacteroides Infections / Q000209:etiology*; D001441:Bacteroides fragilis; D019115:Fasciitis, Necrotizing / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000150:complications*; D012772:Shock, Septic / Q000209:etiology*