A 6-year-old, male child was admitted with history of minor penetrating
injury with nail on anteromedial aspect of left thigh 7 days prior to
admission. Three days later, he developed fever, discoloration of skin
and swelling of left thigh. On examination child was toxic, drowsy,
febrile with poor respiratory effort and shock. Local examination of
left thigh revealed 8×10 cm necrotic area with blue-black discoloration
with marked swelling of thigh and leg with no palpable crepitus (Fig.
1). Investigation revealed multi-organ dysfunction. A diagnosis of
necrotizing fascitis was made. The child was provided intensive
treatment with inotropes, antibiotics and mechanical ventilation and
extensive surgical debridment. Child deteriorated over next 5 days and
expired.
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Fig. 1. Necrotizing fascitis of left thigh. |
Necrotizing fascitis is characterized by involvement
of soft tissue of deep dermis, adipose tissue and subcutaneous fascia.
Hallmark of the disease is extensive areas of both necrosis and
cellulitis. Portal of entry of organisms is usually through a cut or
surgical wound. Common organisms implicated are b-hemolytic group A
streptococci, Pseudo-monas and anerobes. The disease has a varied
spectrum ranging from simple cellulitis to septic shock and multiorgan
dysfunction. Over 50% mortality has been reported. Management of
necrotizing fascitis includes early surgical debridment. Antibiotics
alone do not improve outcome. Amputation can be done in difficult cases.
Role of hyperbaric oxygen is doubtful.
Anil Sachdev,
Sambhavi Seth,
Pediatric Intensive Care Unit,
Department of Pediatrics,
Sir Ganga Ram Hospital,
Rajinder Nagar,
New Delhi 110 060, India.
E-mail:
[email protected]