A 30 year old previously healthy man presents with high fever, tachycardia, hypotension, and severe localized pain of his left lower extremity. The leg has tense edema, red-purple erythema, crepitus, blisters, and bullae, but the pain seems to be greater than he should feel with these findings. The pain has been rapidly increasing over the last day or two. C-reactive protein is 180 mg/L, WBC is 30,000/uL, Hgb is 10 g/dL, sodium is 132 meq/L, Cr is 1.6 mg/dL, glucose is 190 mg/dL. Gram stain is shown above.Challenge: What's the diagnosis? What's the bug?
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Previously Healthy
This is necrotizing fasciitis, Type II. Type I is composed of aerobic and anaerobic bacteria seen in diabetics or after surgery; Type II is from Group A Streptococcus pyogenes (or MRSA). Surgical debridement is the treatment.
Sources: UpToDate; University of Florida Molecular Genetics and Microbiology.
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