Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report
Introduction: Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection caused by fulminant tissue destruction with severe systemic toxicity and a high rate of mortality. It often holds a diagnostic challenge as initially the overlying tissue might appear unaffected. Early surgical i...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Journal of Pediatric Surgery Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576623000088 |
| _version_ | 1797904349113876480 |
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| author | Ágnes Rita Martonosi Piroska Pázmány Márió Mikóczi Diana Molnár Zsuzsanna Zsófia Szalai László Szabó |
| author_facet | Ágnes Rita Martonosi Piroska Pázmány Márió Mikóczi Diana Molnár Zsuzsanna Zsófia Szalai László Szabó |
| author_sort | Ágnes Rita Martonosi |
| collection | DOAJ |
| description | Introduction: Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection caused by fulminant tissue destruction with severe systemic toxicity and a high rate of mortality. It often holds a diagnostic challenge as initially the overlying tissue might appear unaffected. Early surgical intervention parallel with antibiotic therapy forms the basis of appropriate treatment. We present a case admitted with a suspicion of severe allergic reaction due to an insect bite, but finally diagnosed with a NF. Case report: A 17-year old female with swelling, pain and erythema of the left hand was admitted to Heim Pál National Pediatric Institute, Budapest, Hungary on 07.08.2022. She had an insect sting on the same localization one day prior admission. Due to tachycardia and low blood pressure on admission, she was initially mistreated as a severe allergic reaction (anaphylaxis). Laboratory parameters showed elevated inflammatory reaction. Examination of the dorsal area of the left hand revealed swelling and edema with pallor on the fingertips. At the center of the insect bite a pinhead size of a bluish area was seen with one pinhead size of a bulla. Broad spectrum antibiotics (ceftriaxone) was initially started, but sepsis progressed since tachycardia and hypotension persisted. On the second day of hospital stay imaging diagnostics (ultrasound and magnetic resonance imaging) were taken which revealed the signs of NF. High dose penicillin and clindamycin were started and surgical debridement of all necrotic tissues was done. Blood cultures as well as swab culture grew Streptococcus pyogenes. After 4 days of antibiotic treatment and surgical intervention, general condition and symptoms showed rapid improvement. She received 10 days of antibiotic treatment total. Conclusion: This case demonstrates that early diagnosis of NF is crucial. Immediate surgical intervention is needed, regardless of the imaging findings as the delay in surgical intervention can have a great impact on mortality. |
| first_indexed | 2024-04-10T09:47:29Z |
| format | Article |
| id | doaj.art-51284813129a46aba7bfc8dd6f7df5e3 |
| institution | Directory Open Access Journal |
| issn | 2213-5766 |
| language | English |
| last_indexed | 2024-04-10T09:47:29Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj.art-51284813129a46aba7bfc8dd6f7df5e32023-02-17T04:54:19ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662023-03-0190102582Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case reportÁgnes Rita Martonosi0Piroska Pázmány1Márió Mikóczi2Diana Molnár3Zsuzsanna Zsófia Szalai4László Szabó5Heim Pál National Paediatric Institute, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryHeim Pál National Paediatric Institute, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryHeim Pál National Paediatric Institute, Budapest, HungaryHeim Pál National Paediatric Institute, Budapest, HungaryHeim Pál National Paediatric Institute, Budapest, HungaryHeim Pál National Paediatric Institute, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Family Care Methodology Department, Institute of Health Science, Semmelweis University, Budapest, Hungary; Corresponding author. Family Care Methodology Department, Institute of Health Science, Semmelweis University, 1085 Budapest, Üllői út 26., HungaryIntroduction: Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection caused by fulminant tissue destruction with severe systemic toxicity and a high rate of mortality. It often holds a diagnostic challenge as initially the overlying tissue might appear unaffected. Early surgical intervention parallel with antibiotic therapy forms the basis of appropriate treatment. We present a case admitted with a suspicion of severe allergic reaction due to an insect bite, but finally diagnosed with a NF. Case report: A 17-year old female with swelling, pain and erythema of the left hand was admitted to Heim Pál National Pediatric Institute, Budapest, Hungary on 07.08.2022. She had an insect sting on the same localization one day prior admission. Due to tachycardia and low blood pressure on admission, she was initially mistreated as a severe allergic reaction (anaphylaxis). Laboratory parameters showed elevated inflammatory reaction. Examination of the dorsal area of the left hand revealed swelling and edema with pallor on the fingertips. At the center of the insect bite a pinhead size of a bluish area was seen with one pinhead size of a bulla. Broad spectrum antibiotics (ceftriaxone) was initially started, but sepsis progressed since tachycardia and hypotension persisted. On the second day of hospital stay imaging diagnostics (ultrasound and magnetic resonance imaging) were taken which revealed the signs of NF. High dose penicillin and clindamycin were started and surgical debridement of all necrotic tissues was done. Blood cultures as well as swab culture grew Streptococcus pyogenes. After 4 days of antibiotic treatment and surgical intervention, general condition and symptoms showed rapid improvement. She received 10 days of antibiotic treatment total. Conclusion: This case demonstrates that early diagnosis of NF is crucial. Immediate surgical intervention is needed, regardless of the imaging findings as the delay in surgical intervention can have a great impact on mortality.http://www.sciencedirect.com/science/article/pii/S2213576623000088Necrotizing fasciitisSoft tissue infectionStreptococcus pyogenesToxic shock syndromePediatricsCase report |
| spellingShingle | Ágnes Rita Martonosi Piroska Pázmány Márió Mikóczi Diana Molnár Zsuzsanna Zsófia Szalai László Szabó Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report Journal of Pediatric Surgery Case Reports Necrotizing fasciitis Soft tissue infection Streptococcus pyogenes Toxic shock syndrome Pediatrics Case report |
| title | Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report |
| title_full | Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report |
| title_fullStr | Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report |
| title_full_unstemmed | Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report |
| title_short | Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes in a female adolescent – A case report |
| title_sort | necrotizing fasciitis and toxic shock syndrome due to streptococcus pyogenes in a female adolescent a case report |
| topic | Necrotizing fasciitis Soft tissue infection Streptococcus pyogenes Toxic shock syndrome Pediatrics Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2213576623000088 |
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