J Korean Med Sci.  2011 Jan;26(1):131-134. 10.3346/jkms.2011.26.1.131.

Fatal Necrotizing Fasciitis Due to Streptococcus pneumoniae: A Case Report

• Park SY
• Park SY
• Moon SY
• Son JS
• Lee MS

• KMID: 1777987
• DOI: http://doi.org/10.3346/jkms.2011.26.1.131

Abstract

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

Keyword

Fasciitis, Necrotizing; Streptococcus pneumoniae; Korea

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Diabetes Mellitus, Type 2/complications/diagnosis
Fasciitis, Necrotizing/*diagnosis/drug therapy/microbiology/surgery
Fatal Outcome
Humans
Leg/surgery
Liver Cirrhosis/complications/diagnosis
Male
Middle Aged
Streptococcal Infections/*diagnosis/drug therapy
Streptococcus pneumoniae/isolation & purification

Figure

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  Fig. 1 Necrotizing fasciitis of the patient's left leg at admission. Note violet purpuras with unclear margins and bullae of lateral malleolar area.

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  Fig. 2 Intra-operative findings: (A) right hand, (B) left lower leg. It was easy to separate the fascia from the subcutaneous tissue.

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  Fig. 3 Histopathological findings of the soft tissue. (A) The subcutaneous fat tissues showed edematous changes and infiltrates of inflammatory cells mixed with neutrophils (H&E stain, × 100). (B) It shows inflammatory infiltration and thrombosis in the blood vessels (H&E stain, × 400).

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