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Severe soft tissue infection masquerading as necrotising fasciitis in a 31-year-old woman with a background of right thigh arteriovenous malformation
  1. Pennylouise Hever1,
  2. Naveen Cavale1,
  3. Paul Harnett2
  1. 1Department of Plastic and Reconstructive Surgery, King's College Hospital NHS Foundation Trust, London, UK
  2. 2Department of Trauma and Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Pennylouise Hever, phever{at}


A 31-year-old woman with a history of a right thigh arteriovenous malformation presented with an acute history of right thigh pain and swelling. This rapidly progressed to gross sepsis. She was intubated, requiring inotropic support and renal replacement therapy. She was considered disproportionately unwell, with the impression one of necrotising fasciitis (NF). She was taken to theatre for emergency exploration and debridement. There was no evidence of NF to note in theatre. Tissue samples cultured group C Streptococcus, with histopathological examination confirming group C Streptococcal soft tissue infection. Thereafter, she was treated with high-dose intravenous antibiotics, use of a negative pressure wound therapy system, and multiple returns to theatre for repeat debridement. Her condition gradually improved, and she was stepped down to a surgical ward 3 weeks after admission. Nine weeks after initial presentation, she underwent skin grafting for wound closure. She returned to work 7 months later.

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  • Contributors All listed authors made individual contributions to the writing of this article in addition to being involved with the patient's care. PeH was the main contributor responsible for the reporting of the case and will serve as guarantor for the report. NC and PaH supported the planning and development of the initial paper and advised regarding the editors/reviewers comments for the revised draft.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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