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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.
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.
Abstract:
Snakebite envenomation is a life-threatening injury and a neglected public health issue in Africa. We report the case of a child that presented 6 days following a forearm snakebite with compartment syndrome and necrotizing fasciitis of the upper limb extending to the neck and chest who developed mediastinitis. She underwent multiple surgical debridements and the mediastinitis was managed non-surgically with antibiotics and postural drainage leading to recovery. The wounds were later grafted and the child discharged. Extension of necrotizing fasciitis from the limbs to the chest wall with development of mediastinitis is extremely rare with one previous case reported in a woman with poorly controlled diabetes mellitus on immunosuppressive therapy. We report this case due to its unusual presentation with no previous reports found on the development of mediastinitis following snakebite. In conclusion, physicians should have a high index of suspicion for mediastinitis in patients with necrotizing fasciitis extending to the neck and chest following snakebite.
