title: Necrotizing fasciitis and streptococcal toxic shock syndrome secondary to varicella in a healthy child.
abstract: Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome.
authors: Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
authors: Byung Ok
authors: BO
authors: Kwak
authors: Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
authors: Min Jung
authors: MJ
authors: Lee
authors: Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
authors: Hye Won
authors: HW
authors: Park
authors: Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
authors: Min Kyung
authors: MK
authors: Song
authors: Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
authors: Sochung
authors: S
authors: Chung
authors: Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
authors: Kyo Sun
authors: KS
authors: Kim
keywords: Chickenpox; Child; Necrotizing fasciitis; Streptococcus pyogenes
references: J Infect. 2010 Jul;61(1):66-72
references: 20380851
references: Clin Microbiol Infect. 2007 May;13(5):546-9
references: 17378927
references: Eur J Pediatr. 2002 Aug;161(8):442-4
references: 12172829
references: J Pediatr. 2004 Jan;144(1):68-74
references: 14722521
references: Clin Infect Dis. 2005 Apr 1;40(7):1055-7
references: 15825001
references: Pediatr Infect Dis J. 2008 Sep;27(9):847-8
references: 18664930
references: Pediatrics. 2001 Nov;108(5):E79
references: 11694663
references: N Engl J Med. 1991 Nov 28;325(22):1545-50
references: 1658650
references: N Engl J Med. 2005 Feb 3;352(5):450-8
references: 15689583