Varicella is usually considered to be a benign
disease in healthy
children; however, serious
complications can occur such as
necrotizing fasciitis and
toxic shock syndrome. We describe a 38-month-old
girl with
necrotizing fasciitis and streptococcal
toxic shock syndrome following
varicella. She was previously healthy and vaccinated against
varicella at 12 months of age. She had been diagnosed with
varicella three days prior to presenting at our facility; she developed
fever,
vomiting, and painful swelling on her left flank. Her
skin lesions worsened, she became lethargic, and had episodes of
hypotension and coagulopathy.
Necrotizing fasciitis on the left
abdominal wall,
buttocks, and left
thigh was diagnosed by
magnetic resonance imaging, and group A
Streptococcus was isolated from a
tissue culture. She was diagnosed as
necrotizing fasciitis and streptococcal
toxic shock syndrome, and successfully treated with repeated surgical
debridement and
fasciotomy, in addition to intensive
antibiotics. Our experience suggests that
necrotizing fasciitis in
patients with
varicella should be considered to be a rare complication even with widespread
vaccine use.
Early diagnosis and intensive
treatment are required to prevent a
fatal outcome.