title: An aggressive group a streptococcal cellulitis of the hand and forearm requiring surgical debridement.
abstract: Group A streptococcus is responsible for a diverse range of soft tissue infections. Manifestations range from minor oropharyngeal and cellulitic skin infections to more severe conditions such as necrotizing fasciitis and septic shock. Troubling increases in the incidence and the severity of streptococcal infections have been reported over the past 25 years. Cases of streptococcal necrotizing fasciitis have received significant attention in the literature, with prompt surgical debridement being the mainstay of treatment. However, cases of rapidly progressing upper extremity streptococcal cellulitis leading to shock and a subsequent surgical intervention have not been well described. This article presents a case of an 85-year-old woman with a rapidly progressing, erythematous, painful, swollen hand associated with fever, hypotension, and mental status change. Due to a high clinical suspicion for necrotizing fasciitis, the patient was rapidly resuscitated and underwent immediate surgical irrigation and debridement. All intraoperative fascial pathology specimens were negative for necrotizing fasciitis, leading to a final diagnosis of Group A streptococcal cellulitis. Although surgical intervention is not commonly considered in patients with cellulitis, our patient benefited from irrigation and debridement with soft tissue decompression. In cases of necrotizing fasciitis as well as rapidly progressive cellulitis, prompt diagnosis and aggressive treatment may help patients avoid the catastrophic consequences of rapidly progressive group A streptococcal infections.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York, USA. nb954@nyumc.org
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Bharucha
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Alaia
authors.forename: Nader
authors.initials: N
authors.lastname: Paksima
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Christoforou
authors.forename: Salil
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000382:microbiology / Q000473:pathology; D006225:Hand / Q000382:microbiology / Q000473:pathology; D006801:Humans; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013297:Streptococcus pyogenes / Q000302:isolation & purification* / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents