title: [Swollen leg with blisters].
abstract: We report the case of a 84-year-old woman suffering from strong pain in her right leg initially resembling thrombosis of deep veins. Eight hours after admission a superficial blister developed at the calf with following hemorrhagic aspect and spontanous eruption of clear yellowish fluid. Later on a new blister appeared at the thigh. The patient died 33 hours after admission of streptococcal toxic shock syndrome. The latter was based on a necrotizing fasciitis. Streptoccus pyogenes (group A) could be cultivated from the blood and fluid of the blister. We discuss the clinical presentation of necrotizing fasciitis with "pain out of proportion" as characteristic complaint and the appropriate management.
authors.affiliation: Medizinische Klinik, Spital Zofingen. RafeinerP@uhbs.ch
authors.forename: Ph
authors.initials: P
authors.lastname: Rafeiner
authors.forename: A J
authors.initials: AJ
authors.lastname: Templeton
authors.forename: H J
authors.initials: HJ
authors.lastname: Vonesch
mesh_terms: D000369:Aged, 80 and over; D001768:Blister / Q000209:etiology*; D003937:Diagnosis, Differential; D004487:Edema / Q000209:etiology*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis*; D017809:Fatal Outcome; D005260:Female; D005734:Gangrene / Q000175:diagnosis; D006801:Humans; D007868:Leg Dermatoses / Q000209:etiology*; D009102:Multiple Organ Failure / Q000175:diagnosis; D012772:Shock, Septic / Q000175:diagnosis*; D012867:Skin / Q000473:pathology; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes