A 62-year-old man with no antecedents of interest was admitted to the Burns Unit of our Hospital from his reference center with the diagnosis of chemical burn in the right lower limb of 24 hours of evolution.
On physical examination, the patient was found to be afebrile, presenting pain in the right lower limb with erythema and areas of necrosis on the back of the foot and the anterior face of the rectum.
No other pathological data were observed.
At admission, the following results were obtained: Hemoglobin 13, mEq1 gr/dl; Protein creatinine 37,9%; Leukocytes 3,370 per μl (neutrophils 88,4%); Creatinine 37,9%/Udl
With the initial diagnosis of chemical consolidation of third degree in the lower extremity, scarotomies and resuscitation with serum therapy are performed under sedation.
24 hours after admission, progression of necrosis and erythema to the abdomen was observed, with a slight improvement in renal function (Urea: 188 mg/dl; Creatinine 2.7 mg/dl) and tachycardia with CPK 9.782 IU/dl.
The patient's family reveals that four days before he had had a small trauma to the right knee that caused allergic contact with a medication. On the following day, the appearance of an erythematous-violaceous area was observed.
With the diagnosis of septic shock after necrotizing fasciitis in the right lower limb, urgent surgical intervention is indicated, performing facial debridement; when muscular necrosis at the level of the thigh is confirmed, an empirical co-infection with antibiotics is performed.
In the microbiological culture of fascia and muscle, streptococcus Pyogenes was isolated and the histology showed dermal necrosis, subcutaneous cellular tissue, fascia and muscle with the presence of Gram positive cocci.
The patient had a satisfactory clinical course, performing secondarily coverage of the stump with a pedunculated myocutaneous flap of the anterior rectum.
