[Lethal end of a group C streptococcal necrotizing fasciitis in a healthy female].
The necrotizing fasciitis (NF) is a life threatening, quickly progressive soft-tissue infection characterized by necrosis of the superficial fascia. It is very rare in the head and neck region. Usually this infection attacks weak patients with chronic diseases, such as diabetes or cancer. In adults the most common organisms implicated in craniocervical NF are Streptococcus pyogenes, Staphylococcus aureus, Streptococcus viridans and Peptostreptococci. The typical infectious entrance is a deep wound, after surgery or a peritonsillar abscess. We describe a very unusual case of a craniocervical NF with a deadly outcome in a sixty year old female. The patient had no chronic diseases and went to an ENT doctor with an acute tonsillitis for 3 days. Within the next three hours the general condition became dangerous to life. Therefore she was brought to us for immediate therapy. But despite fast and aggressive surgery of the neck, throat and thorax the patient died of a toxic schock syndrome on the intensive care unit within a few hours. The microbiology showed just group C Streptococcus. The postmortem examination confirmed the NF with starting point in the left tonsil after acute tonsillitis. Such a foudroyant course of a craniocervical NF with group C streptococci in a healthy patient is not published yet.
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde der Ludwig-Maximilians-Universität München, Klinikum Grosshadern und Innenstadt. klaus.stelter@med.uni-muenchen.de
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D000208:Acute Disease; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology* / Q000401:mortality* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D013291:Streptococcus / Q000302:isolation & purification*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014069:Tonsillitis / Q000150:complications* / Q000382:microbiology