Rare presentation of necrotising fasciitis and streptococcal toxic shock syndrome by group A streptococcus

Description

A 44-year-old healthy male presented to the emergency room with a 6-day history of right medial thigh pain and itching. Examination revealed mild erythema with superficial swelling, but no tenderness (figure 1A). Vital signs were stable. White cell count (WBC) was 11.2x10⁹/L with no other significant laboratory abnormality. During the next 6 hours, his erythema and swelling extended to involve the whole thigh with the patient getting septic (spiking 102°F, heart rate 110/min and blood pressure 118/79 mm Hg). WBC trended up to 23x10⁹/L and lactate 4.7 mmol/L. MRI was performed which showed possible myositis (figure 1B). Despite intravenous antibiotics (penicillin and vancomycin) and resuscitation, his clinical condition deteriorated rapidly. In the next 4 hours, patient was taken to the operative room for fasciotomy and exploration. Intraoperatively, patient was found to have fasciitis. Necrotic tissue was removed.

Figure 1

(A) Right medial thigh with mild erythema. (B) MRI of the lower...

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