Successful Treatment of Necrotizing Fasciitis Caused by Streptococcus pyogenes

Abstract

A 36-year-old woman hurt her right foot on a refrigerator and developed a bruise. The pain worsened and she developed a fever. She was referred to our hospital on the following day with erythema, swelling, and local heat on her lateral malleolus, accompanied by a high fever and significant pain in the whole right foot. A blood test revealed a marked elevation of inflammatory marker levels, and her LRINEC score was 4. Although the administration of antibiotics was initiated owing to a suspicion of cellulitis, the patient went into shock after half a day. A follow-up examination revealed a further elevation of inflammatory marker levels, decreased renal function, and increased coagulation parameters, and her LRINEC score was 8. She had also developed blisters on the dorsum of the foot. As the findings of an exploratory incision indicated necrotizing fasciitis, surgical debridement was performed immediately, and Streptococcus pyogenes (S. pyogenes) was detected from all surgical samples. The administration of ampicillin and clindamycin was continued for 2 weeks along with intravenous immunoglobulin. There was no relapse of infection, and she underwent skin grafting on day 47, after which her foot was preserved without any severe sequela. S. pyogenes, by itself, can cause necrotizing fasciitis in persons without any underlying illness. In some cases, infection with S. pyogenes may result in a condition with a high mortality rate, i.e., streptococcal toxic shock syndrome. In the present case, although the patient had developed necrotizing fasciitis due to S. pyogenes and subsequently went into shock, we were able to save her life and leg owing to an early diagnosis and an early initiation of therapy. As necrotizing fasciitis caused by S. pyogenes requires prompt and careful treatment, we report the present case to share this valuable experience.