title: Necrotizing fasciitis of the upper extremity resulting from a water moccasin bite.
abstract: Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture. The patient was treated with antivenom, a diuretic regimen, broad spectrum antibiotics, and 18 separate surgical procedures. After the application of skin grafts, the wound completely healed. This case illustrates that a venomous snakebite may result in infection with A hydrophila and can cause severe necrotizing fasciitis. Early and aggressive surgical intervention should be implemented as soon as the necrotizing fasciitis is diagnosed.
mesh_terms: D000328:Adult; D016980:Aeromonas hydrophila; D000818:Animals; D017812:Colubridae; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000601:surgery*; D016905:Gram-Negative Bacterial Infections / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D016038:Skin Transplantation; D012909:Snake Bites / Q000150:complications* / Q000628:therapy