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Necrotizing fasciitis with mediastinitis following snakebite envenomation

Chihena Hansini Banda1, Chandwa N'gambi1

  • 1Department of Surgery, Arthur Davison Children's Hospital, Ndola, Zambia.

SAGE Open Medical Case Reports
|January 24, 2019
PubMed

Insights

Snakebite envenomation can lead to severe necrotizing fasciitis. This case highlights the rare complication of mediastinitis following a snakebite, emphasizing the need for high clinical suspicion.

Area of Science:

  • Medical Case Report
  • Infectious Diseases
  • Toxicology

Background:

  • Snakebite envenomation is a significant public health concern in Africa, often leading to severe complications.
  • Necrotizing fasciitis is a rapidly progressing bacterial infection that can result from envenomation.
  • Mediastinitis, an infection of the mediastinum, is a rare but life-threatening complication.

Observation:

  • A child presented with compartment syndrome and necrotizing fasciitis of the upper limb six days after a forearm snakebite.
  • The necrotizing fasciitis extended to the neck and chest, subsequently leading to mediastinitis.
  • The patient had no pre-existing conditions like diabetes or immunosuppression that typically predispose to such severe infections.

Findings:

  • The mediastinitis was successfully managed non-surgically with antibiotics and postural drainage.
  • Multiple surgical debridements were performed for the necrotizing fasciitis.
  • The patient recovered and was discharged after wound grafting.

Implications:

  • This case represents an extremely rare presentation of mediastinitis following snakebite, with no prior reports in immunocompetent individuals.
  • Physicians should maintain a high index of suspicion for mediastinitis in snakebite patients with extensive necrotizing fasciitis involving the neck and chest.
  • Early recognition and appropriate management are crucial for improving outcomes in severe snakebite complications.

Keywords:
AfricaCritical care/emergency medicineZambiacompartment syndromeinfectious diseasesmediastinitisnecrotizing fasciitissnakebitesurgery

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