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 (10×8 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.

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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.