title: Bilateral Necrotizing Fasciitis of the Foot Associated with Group B Streptococcus.
abstract: Necrotizing fasciitis (NF) is a severe bacterial infection involving fascia and subcutaneous tissue. It generally affects upper or lower extremities unilaterally, and there are few reports of bilateral-extremity NF. Here, we report a case of a 43-year-old male with type 1 diabetes who had NF on the left foot and subsequently developed NF on the other foot 1 week later. The patient survived with antimicrobial therapy and bilateral below-knee amputation. As group B streptococcus (GBS) was isolated by blood culture and culture of excised tissues of both feet, bilateral GBS NF of the foot was diagnosed. GBS is a rare causative pathogen in NF; however, there have been two case reports of bilateral GBS NF of an extremity in which NF appeared on the opposite extremity 1 week after the primary site infection, as in our case. GBS was isolated from cultures of blood and excised tissues of both extremities in both cases. Together, these observations suggest that GBS has a potential to cause secondary NF at remote sites by hematogenous dissemination with approximately 1 week delay and thereby lead to bilateral NF.
authors: Department of Dermatology, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors: Keitaro
authors: K
authors: Fukuda
authors: Department of Dermatology, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors: Misao
authors: M
authors: Ryujin
authors: Department of Plastic and Reconstructive Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors: Reiko
authors: R
authors: Sakio
authors: Department of Plastic and Reconstructive Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors: Satoshi
authors: S
authors: Fukuzumi
authors: Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors: Takanori
authors: T
authors: Omae
authors: Department of Dermatology, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors: Kazuhito
authors: K
authors: Hayakawa
keywords: Diabetes; Group B streptococcus; Lower extremity; Necrotizing fasciitis, bilateral