Group G Streptococcal Necrotizing Soft Tissue Infection

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  • MAEHARA Eriko
    Department of Dermatology, Graduate School of Medical Sciences, Kyushu University
  • TSUJI Gaku
    Department of Dermatology, Graduate School of Medical Sciences, Kyushu University
  • MIZOTE Yukihiro
    Department of Dermatology, Graduate School of Medical Sciences, Kyushu University
  • TAKEUCHI Naohide
    Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
  • FURUE Masutaka
    Department of Dermatology, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • G 群溶連菌感染による壊死性軟部組織感染症の 1 例
  • 症例 G群溶連菌感染による壊死性軟部組織感染症の1例
  • ショウレイ Gグン ヨウレンキン カンセン ニ ヨル エシセイナンブ ソシキ カンセンショウ ノ 1レイ

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Abstract

<p>We report a rare case of streptococcal necrotizing soft tissue infection in the lower leg caused by Group G Streptococcus infection. A 61-year-old female had idiopathic lymph edema of the left leg. She complained of swelling and burning of the leg after pharyngitis and flulike symptoms with high fever. Laboratory examinations showed elevated white blood cells (11110/μl), creatine phosphokinase (1781 U/l), and C-reactive protein (CRP ; 25.86 mg/dl). Magnetic resonance imaging (MRI) T1-weighted imaging showed a high-intensity area in the muscle, suggesting muscle necrosis with hemorrhage. MRI T2-weighted imaging also showed the presence of a high-intensity area in subcutaneous tissue and superficial fascia. Over a few hours, redness and purpura of the left leg progressed rapidly. We performed a fasciectomy and debridement 7 hours after admission. At the fasciectomy, the subcutaneous tissue, superficial fascia and muscle appeared necrotic with a large amount of translucent fluid. Considering the findings that (1) group G Streptococcus was isolated from blood cultures, (2) a blood coagulation test suggested disseminated intravascular coagulation, and (3) deep soft tissue infection or necrotizing fasciitis was observed, we diagnosed a toxic shock-like syndrome. She was treated with penicillin, clindamycin, and meropenem antibiotics in combination with intravenous immunoglobulin administration. Because this treatment was insufficient to improve the elevated CRP, we again performed MRI analysis to evaluate whether other areas of necrotic tissue remained in the leg. MRI T1-weighted imaging still showed the presence of a high-intensity area in the gastrocnemius, suggesting that the streptococcal infection had resulted in necrosis of the muscle. We performed debridement of the necrotic gastrocnemius and tibialis anterior muscles, which successfully improved her general condition and laboratory data. Subsequently, she underwent split-skin grafting and was discharged.</p>

Journal

  • Nishi Nihon Hifuka

    Nishi Nihon Hifuka 78 (6), 644-649, 2016

    Western Division of Japanese Dermatological Association

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