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Necrotizing fasciitis following drainage of Streptococcus milleri empyema

Peter Tcherveniakov1, Eirik Svennevik, Kallirroi Tzafetta

  • 1Department of Thoracic Surgery, St. James's Hospital, Leeds, UK. pcherv@hotmail.com

Interactive Cardiovascular and Thoracic Surgery
|December 23, 2009
PubMed

Insights

Streptococcus milleri (SM) infections can lead to severe chest wall complications like necrotizing fasciitis. Aggressive surgical intervention, including debridement and flap reconstruction, is crucial for managing these resistant purulent infections.

Area of Science:

  • Medical Microbiology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Streptococcus milleri (SM) is a group of bacteria known to cause difficult-to-treat purulent infections in the chest.
  • Mediastinal and pleural space infections caused by SM often necessitate aggressive surgical approaches due to their resistance to treatment.

Observation:

  • A 60-year-old patient developed necrotizing fasciitis of the chest wall following bedside drainage of an SM empyema.
  • The patient presented with extensive soft tissue loss requiring significant surgical debridement.

Findings:

  • The necrotizing fasciitis necessitated extensive debridement of the chest wall.
  • Latissimus dorsi flap reconstruction was performed to cover the resulting large soft tissue defect.

Implications:

  • This case highlights the potential for severe complications arising from SM infections, even after initial drainage.
  • Effective management requires a multidisciplinary approach involving infectious disease specialists and thoracic surgeons.
  • Complex reconstructive techniques may be essential for successful outcomes in managing SM-related chest wall defects.

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