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Necrotizing fasciitis complicating disseminated cutaneous herpes zoster
Abstract:
The association of necrotizing fasciitis, often due to group A streptococcus and primary varicella (chicken pox), is unusual but recognized in children. The association in adults is rare but one report in the literature describes a previously healthy man with the two disorders. We now describe a case of disseminated cutaneous herpes zoster complicated by subacute necrotizing fasciitis in an elderly woman taking low dose methotrexate and prednisone for rheumatoid arthritis. Staphylococcus aureus was isolated. Localized debridement and split skin grafting were required.
Insights
Necrotizing fasciitis is rarely associated with herpes zoster, especially in adults. This case highlights a rare instance in an elderly woman with rheumatoid arthritis, complicated by Staphylococcus aureus.
Area of Science:
- Infectious Diseases
- Dermatology
- Rheumatology
Background:
- Necrotizing fasciitis (NF) is a severe soft tissue infection.
- Association of NF with viral infections like varicella is documented, though rare in adults.
- Herpes zoster (shingles) is a reactivation of the varicella-zoster virus.
Observation:
- A case of disseminated cutaneous herpes zoster in an elderly woman.
- The patient had rheumatoid arthritis and was on low-dose methotrexate and prednisone.
- Subacute necrotizing fasciitis developed as a complication.
Findings:
- Staphylococcus aureus was isolated from the affected tissue.
- The patient required surgical debridement and split-skin grafting.
- This represents a rare association between herpes zoster and necrotizing fasciitis in an immunocompromised adult.
Implications:
- Highlights a rare but severe complication of herpes zoster in immunocompromised patients.
- Emphasizes the importance of considering bacterial superinfection in viral skin lesions.
- Suggests vigilance for necrotizing fasciitis in patients with herpes zoster, particularly those on immunosuppressive therapy.