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Invasive group A streptococcal diseases are increasing, and range from noninvasive infections such as pharyngitis or impetigo to life-threatening conditions such as bacteremia, toxic shock syndrome, and necrotizing fasciitis.1 This article presents a complicated case of invasive group A streptococcal disease in which infection with these bacteria was not plausible.
CASE REPORT
A healthy 22-year-old woman presented to our emergency room seven days after spraining her right ankle while playing soccer. Initial treatment consisted of immobilization with a cast. At presentation she complained of pain, a swollen lower leg. edema, erythema, and blisters of approximately seven hours of evolution.
The patient was alert and had normal vital signs and no fever. Clinical evaluation showed no abnormal cardiopulmonary or abdominal findings. Erythema was found along the path of the interior saphena, and die leg was cold and without pedal and popliteal pulses but with three-fifths osteotendinous reflexes. The patient felt numbness and pain from the ankle to the knee that increased with movement.
White blood cell count was normal but had 90.6% polymorphonuclear cells, 17.3 g/dL of hemoglobin, 51.2% hematocrit and prothrombin time international normalized ratio of 1.5. The rest of the biochemical and biocellular parameters were normal; Doppler reported diminished popliteal pulse and lack at the pedal level.
The patient was rehydrated, and fresh frozen plasma and broad-spectrum antibiotics (imipenem, 500 mg/6 hours and clindamycin 900 mg/8 hours) were administered intravenously. The patient underwent emergency fasciotomy. During surgery, necrosis of the subcutaneous and muscular tissue was found. No recovery of tissues was gained. Blood and secretion cultures as well as biopsies of the necrotic tissue were obtained.
Femoral arteriography showed 100% obstruction at the distal femoral level, thrombectomy with a 5 French Fogarty was unsuccessful and soleus and gastrocnemius muscles were found to be necrotic...