[Necrotizing fasciitis with toxic shock-like syndrome. Case report]

Fulminant group A streptococcal infection with necrotizing fasciitis and toxic shock-like syndrome is rare in Taiwan. We had diagnosed a case of necrotizing fasciitis with toxic shock-like syndrome in January, 1990. Tracing the patient's history, he was rather well in the past except that he scratched his skin occasionally. Erythromatous change with swelling and painful sensation of skin over medial aspect of left thigh was noted 4 days before admission. He called on local dermatologist and was treated with some topical medication. Unfortunately, the condition went downhill within 2 days with the lesion extending to the scrotum and causing vesicular formation and necrotic change of the skin over left thigh and scrotum. He was sent to our Emergency Room in shock condition and was admitted under impression of necrotizing fasciitis with septic shock. Incision and drainage was done in the second hospital day and group A streptococcus was isolated from blood and skin later. His condition became stable slowly. Due to extensive necrosis of skin and subcutaneous tissue, debridement had been done twice and skin graft was done one month after admission. We report this case to emphasise the rare but fulminant nature of group A streptococcal necrotizing fasciitis with toxic shock-like syndrome and the importance of early surgical and medical management.