Necrotizing Fasciitis After Herpes Zoster Infection: A Rare Case With Diagnostic Difficulties

Area of Science:

• Infectious Diseases
• Dermatology
• Surgical Infections

Background:

• Herpes zoster (shingles) can rarely lead to necrotizing fasciitis, a severe soft tissue infection.
• Bacterial superinfection of herpes zoster lesions can mask or delay the diagnosis of necrotizing fasciitis.
• Early recognition is critical due to the high morbidity and mortality associated with necrotizing fasciitis.

Observation:

• A 59-year-old female with diabetes and bilateral herpes zoster (C7-T8 dermatomes) presented with sepsis.
• She had been treated with oral antibiotics for presumed bacterial superinfection of her zoster lesions.
• Her Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 10, indicating high suspicion.

Findings:

• Necrotizing fasciitis can develop as a complication of herpes zoster, even with antibiotic treatment for secondary bacterial infections.
• The LRINEC score is a valuable and practical tool for differentiating necrotizing fasciitis from simple bacterial superinfections.
• A high LRINEC score (≥10) warrants prompt inpatient evaluation and management.

Implications:

• Clinicians should consider necrotizing fasciitis in the differential diagnosis of patients with herpes zoster and signs of sepsis or worsening infection.
• Timely diagnosis and management of necrotizing fasciitis, aided by the LRINEC score, can significantly reduce mortality and morbidity.
• Patients with suspected necrotizing fasciitis require immediate inpatient care and aggressive treatment, potentially including surgical intervention.