Pseudomonas Necrotizing Fasciitis in an Otherwise Healthy Infant

Necrotizing fasciitis is an uncommon rapidly progressing infection of soft tissue characterized by a severe inflammation of the fascia and soft tissue. The disease is associated with necrosis and subcutaneous gangrene of the inflamed tissue with systemic toxicity that carries a significant mortality unless timely diagnosed and aggressively treated. Monomicrobial necrotizing fasciitis caused by Pseudomonas aeruginosa is an exceptionally uncommon condition with only few cases reported in the literature so far. We are reporting a six-month-old female infant who was previously healthy and who presented with necrotizing fasciitis and isolates Pseudomonas aeruginosa both from the blood and tissue. The child improved after the intensive treatment. 1. Introduction Necrotizing fasciitis (NF) is a severe soft tissue potentially fatal bacterial infection characterized by rapid progressing necrosis involving mainly the fascia and subcutaneous tissue but can also extend to involve muscles and skin [1]. This rare, life-threatening condition has been recognized since the fifth century BC [2]. All age groups, including neonates, can be affected [3]. Reported incidence in the literature has been described as 0.08 per 100000 children per year with most lesions reported on the trunk [4]. It frequently affects a previously healthy children [5] and results in a significant rate of mortality as well as morbidity if there is any delay in diagnosis and treatment [6]. Accurate early diagnosis and surgical intervention combined with administration of appropriate parenteral antibiotics have been the cornerstones of NF treatment [7]. We are reporting here a case of a six-month-old female infant who was previously well, diagnosed as necrotizing fasciitis secondary to Pseudomonas aeruginosa—rare cause of NF in an otherwise healthy infant. 2. Case Report A six-month-old female infant presented with the 7 days history of high fever and rashes over both thighs, visiting from USA since birth and was previously well. The birth and developmental history were unremarkable and she was fully vaccinated accordingly. There was no history of apparent predisposing factor including drug or insect bite. Examination revealed a well thriving, febrile, irritable child with pulse of 100 beats per minute, maintaining saturation in room air and was normotensive (90/60？mmHg). Local examination revealed erythema fulminans measuring ？cm over right leg and left thigh (3 × 5？cm) with well circumscribed margins and surrounding blisters (Figure 1). These lesions were tender and warm on palpation. Rest of the