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.

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]