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Necrotising fasciitis complicating varicella

F M de Benedictis, P Osimani

Department of Pediatrics, Salesi Children’s Hospital, Ancona, Italy

Correspondence to:
debenedictis{at}ao-salesi.marche.it

A 2-year-old girl was admitted for fever, irritability and increasing complaint of pain and swelling in the right quadrant of the abdomen following varicella. Physical examination revealed a few skin lesions in various stages of evolution, and a large (10x8 cm), painful, erythematous, oedematous plaque on the right abdomen. Over the following 2 days, the lesion rapidly increased in size and became ulcerated. The lesion was covered by a whitish, necrotic eschar and was delimited by raised, reddish edges (fig 1). Fasciitis was diagnosed. Group A beta-haemolytic Streptococcus (GABHS) was isolated from the lesion. Repeated surgical debridements and local dressing in addition to intensive antibiotic treatment and nutritional support were required. The patient was discharged after 2 weeks in good health condition and with healing skin lesions. She completely recovered within a 3-month period.

View this figure (123K): in this window | in a new window | PowerPoint for Teaching   Figure 1 Lesion on child’s right abdomen.

 

Varicella is a disease that can provoke serious complications and long hospital stays.¹ Although the risk for acquiring invasive GABHS disease, including necrotising fasciitis, in patients with recent varicella infection is increased,^{2 3} patients often experience a delay in initial diagnosis.⁴ Early recognition of necrotising fasciitis by primary care physicians is critical. It should be suspected in any child with a recent history of varicella infection and an increased complaint of pain and/or swelling in any body area, associated with increasing fever, lethargy and irritability. Fatal consequences can occur when necrotising fasciitis is unrecognised or diagnosed late, and when an intensive, multidisciplinary therapeutic approach is not adopted.

This article has been adapted from de Benedictis F M, Osimani P. Necrotising fasciitis complicating varicella ADC 2008;93:619

Competing interests: None.

Patient consent: Parental/guardian informed consent was obtained for publication of the child’s details in this report.

1. Marchetto, S, de Benedictis, FM, de Martino, M, et al. Epidemiology of hospital admissions for chickenpox in children: an Italian multicenter study in the pre-vaccine era. Acta Paediatr 2007; 96: 1490–3.[CrossRef][Medline]
2. Eneli, I, & Davies, HD. Epidemiology and outcome of necrotizing fasciitis in children: an active surveillance study of the Canadian Pediatric Surveillance Program. J Pediatr 2007; 151: 79–84.[CrossRef][Medline]
3. Cameron, JC, Allan, G, Johnston, F, et al. Severe complications of chickenpox in hospitalised children in the UK and Ireland. Arch Dis Child 2007; 92: 1062–6.[Abstract/Free Full Text]
4. Brogan, TV, Nizet, V, Waldhausen, JH, et al. Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients. Pediatr Infect Dis 1995; 14: 588–94.

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