Introduction. 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.
Case Outline. 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 day s ea rlier with m alaise, chills and shivering. On
admission he was hypotensive, anuric, with erythematous rash on his face,
neck and chest, with acute ren al 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 subcutaneo
us bleeding, indicating NF. Aggressive antimicrobial, supportive and symptom
atic 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. Stre ptococcus pyogenes (group A ?-hemolytic Streptococcus) was
isolated from the throat, skin and tissue obtained duri ng the surgery.
Conclusion. Necrotizing fasciitis is a very serious disease with unpre
dictable course. For that reason doctors must devote a great deal of a
ttention to early, i.e. timely diagnosis of this disease, whose treatment
with a multid isciplinary approach is very important.
675: FATAL OUTCOME OF NECROTIZING FASCIITIS DUE TO AEROMONAS SPECIES WITH ASSOCIATED BACTEREMIA
