title: Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients.
abstract: BACKGROUND
  Necrotizing fasciitis is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Examination of deep incisional biopsy specimens can provide prompt diagnosis and improve survival. We describe 7 patients with necrotizing fasciitis caused by group A Streptococcus species.
  
  
  OBJECTIVE
  Our purpose was to describe the unique dermatopathology and clinical features in 7 patients with necrotizing fasciitis caused by group A Streptococcus.
  
  
  METHODS
  We conducted a retrospective review.
  
  
  RESULTS
  The average age of the patients was 47 years. Fasciitis occurred on an extremity in all cases. All 5 patients with streptococcal toxic shock syndrome died of their disease. The histopathologic findings from early fascial disease revealed superficial epidermal necrosis, edema, and hemorrhage with few inflammatory cells, whereas clinically advanced, necrotic skin lesions revealed diffuse necrosis, thrombosis, neutrophilia, and numerous gram-positive diplococci.
  
  
  CONCLUSIONS
  Patients with clinical features of necrotizing fasciitis should have a deep incisional biopsy specimen obtained from the central area of ecchymotic, necrotic plaques to confirm the diagnosis. Immediate surgical intervention is necessary to reduce the morbidity and mortality rates associated with necrotizing fasciitis.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, USA.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Dahl
authors.forename: Charles
authors.initials: C
authors.lastname: Perniciaro
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Holmkvist
authors.forename: Mary I
authors.initials: MI
authors.lastname: O'Connor
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Gibson
mesh_terms: D000328:Adult; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000382:microbiology; D012867:Skin / Q000473:pathology; D013297:Streptococcus pyogenes