Korean J Pediatr.  2014 Dec;57(12):538-541. 10.3345/kjp.2014.57.12.538.

Necrotizing fasciitis and streptococcal toxic shock syndrome secondary to varicella in a healthy child

• Kwak BO
• Lee MJ
• Park HW
• Song MK
• Chung S
• Kim KS

• KMID: 2284644
• DOI: http://doi.org/10.3345/kjp.2014.57.12.538

Abstract

Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome.

Keyword

Chickenpox; Necrotizing fasciitis; Streptococcus pyogenes; Child

MeSH Terms

Abdominal Wall
Anti-Bacterial Agents
Buttocks
Chickenpox*
Child*
Child, Preschool
Debridement
Early Diagnosis
Fasciitis, Necrotizing*
Fatal Outcome
Female
Fever
Humans
Hypotension
Magnetic Resonance Imaging
Shock, Septic*
Skin
Streptococcus
Streptococcus pyogenes
Thigh
Vomiting
Anti-Bacterial Agents