Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block.

Nseir, S; Pronnier, P; Soubrier, S; Onimus, T; Saulnier, F; Mathieu, D; Durocher, A · Br J Anaesth · 2004

case_report · Level V

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Abstract

A 74-yr-old diabetic woman developed necrotizing fasciitis of the right upper limb after axillary brachial plexus block for carpal tunnel decompression. Clinical signs included oedema, diffuse swelling and bullae; rapidly followed by toxic shock syndrome and multiorgan failure. The patient died 48 h after hospital admission, despite broad-spectrum antibiotics, surgical treatment and supportive measures for the management of shock and multiorgan failure. Cultures yielded group A Streptococcus. Delay in antibiotic and surgical treatment probably affected the outcome. Early diagnosis and treatment are essential to improve the outcome of streptococcal necrotizing fasciitis.

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