Necrotizing fasciitis after varicella infection in children: A case series

• Published in: Journal of pediatric surgery case reports Vol. 98; p. 102725
• Main Authors: Lovis, Jonathan, Krebs, Thomas, Grünert, Jörg, Häcker, Frank-Martin
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2023; Elsevier
• Subjects: Case series; Necrotizing fasciitis; Varicella-Zoster Virus; Necrotizing fasciitis; Varicella-Zoster Virus; Case series
• ISSN: 2213-5766; 2213-5766
• DOI: 10.1016/j.epsc.2023.102725

Necrotizing fasciitis is a rare but serious complication that can occur in children with chickenpox, even in immunocompetent children. Prompt diagnosis and immediate surgical treatment are mandatory to avoid potentially fatal complications. The first patient was an 8-year-old female who presented with a 3-day history of varicella infection. Clinical examination revealed general varicella-related exanthema with necrotizing fasciitis in the left groin. In addition to immediate parenteral antibacterial treatment, emergency surgical exploration was done within 3 hours of arrival to the emergency department. Wide surgical debridement was the initial treatment. Primary closure was achieved using a rectus abdominis myocutaneous (RAM) pedicled flap. The postoperative course was uneventful. The second patient was a 6-year-old male with a history of renal disease who presented with a 3-day history of varicella infection to our emergency department. The patient was in a poor general condition and was initially treated with antibiotics for presumed urosepsis. After approximately 2 hours, he developed clear signs of necrotizing fasciitis in the right hemiscrotum. Surgical debridement was immediately performed, but the patient eventually succumbed due to uncontrolled sepsis. Necrotizing fasciitis is a potential complication of patients with chickenpox. Emergent surgical debridement is mandatory.