Case Report: Case Presentation: Infant is a 7 day old 30 week, twin B, transferred from another hospital for worsening erythema and swelling of the right hand and arm for 3 days due to phlebitis from a PICC line. Infant had RDS initially for which he required surfactant and subsequent CPAP. A PICC line was placed on day of life 3 in the right arm. On DOL 6, Infant became febrile and swellig and erythma of the PICC insertion site noted which progressed upto hand in a day. PICC linewas removed and a new PICC line was inserted in the left arm. Blood culture was obtained and the infant started on Van & Gent as Infant was febrile (CBC benign, CRP-4.2). On DOL 7, the right hand, arm became more erythematous and swollen which coincided with a positive blood culture for gram positive cocci, Clindamycin added. A Doppler showed an abscess in the right mid-arm. A Orthopedist consulted and abcess incised, drained. MRI right upper extremity concerning for necrotizing fasciitis. Infant then transferred to our institution for further management. Physical examination at our institution was notable for tense swelling proceeding from the right hand to the ipsilateral hemithorax with significant erythema and discoloration of the right forearm. Perfusion of the right hand was poor with a prolong capillary refill time and absent pulses. Diagnosis of compartment syndrome made, Infant underwent fasciotomy. Noted to have non-viable subcutaneous tissue, large amount of cloudy fluid and pale muscles intra-operatively. Antibiotics were continued and serial blood cultures obtained. MRSA(Methicillin Resistant Staphylococcus Aureus) was persistently isolated from blood cultures for 3 days necessisating the addition of Rifampin. Infant required vigourous supportive measures. Received Vancomycin for total of 3 weeks from the first negative blood culture. At the end of therapy, fasciotomy wounds healed well and infant moved fingers and arms spontaneously. This case highlights the invasive nature of this condition, the need for prompt recognition and intervention.
Patel, P., Panglao, M., Cash, L., Darby, S., Yu, J., Bhatia, J., & Parrish, A. (2014). Infant with MRSA necrotizing fasciitis. Research and Reports in Neonatology, 87. https://doi.org/10.2147/rrn.s58358