Streptococcal Necrotizing Fasciitis with Toxic Shock Syndrome and Rapid Fatal Outcome.
BACKGROUND
Streptococcal necrotizing fasciitis (NF) is a serious soft tissue infection with rapid progression of inflammatory process among superficial or deep fascia, systemic host response to infection leading to toxic shock syndrome (TSS), and multiple organ failure. Lethality is high.


METHODS
A 46-year-old male without co-morbidities was admitted to the Emergency Department with redness, swelling and pain on his right lower leg. He became sick two days earlier with malaise, chills and shivering. On admission he was hypotensive, anuric, with erythematous rash on his face, neck and chest, with acute renal failure and elevated creatine phosphokinase level. During the next several hours, the changes on his right lower leg rapidly spread to the whole leg, followed by skin destruction and subcutaneous bleeding, indicating NF. Aggressive antimicrobial, supportive and symptomatic therapy was initiated immediately and on the same evening surgical intervention was performed. Despite these measures, a rapid development of severe TSS, with lethal outcome, occurred in less than 40 hours after the admission. Streptococcus pyogenes (group A β-hemolytic Streptococcus) was isolated from the throat, skin and tissue obtained during the surgery.


CONCLUSIONS
Necrotizing fasciitis is a very serious disease with unpredictable course. For that reason doctors must devote a great deal of attention to early, i.e. timely diagnosis of this disease, whose treatment with a multidisciplinary approach is very important.
Miroslav
M
Kojič
Dragan
D
Mikič
Darko
D
Nožić
Bojan
B
Rakonjac
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000302:isolation & purification
D000900:Anti-Bacterial Agents