Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block.
A 74-yr-old diabetic woman developed necrotizing fasciitis of the right upper limb after axillary brachial plexus block for carpal tunnel decompression. Clinical signs included oedema, diffuse swelling and bullae; rapidly followed by toxic shock syndrome and multiorgan failure. The patient died 48 h after hospital admission, despite broad-spectrum antibiotics, surgical treatment and supportive measures for the management of shock and multiorgan failure. Cultures yielded group A Streptococcus. Delay in antibiotic and surgical treatment probably affected the outcome. Early diagnosis and treatment are essential to improve the outcome of streptococcal necrotizing fasciitis.
Nseir
S
S
Service de Réanimation Médicale, Hôpital Calmette, CHRU, boulevard du Pr Leclercq, F-59037 Lille cedex, France. s-nseir@chru-lille.fr
Pronnier
P
P
Soubrier
S
S
Onimus
T
T
Saulnier
F
F
Mathieu
D
D
Durocher
A
A
D000368:Aged; D001917:Brachial Plexus; D002349:Carpal Tunnel Syndrome / Q000601:surgery; D003428:Cross Infection / Q000209:etiology*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects*