Necrotizing fasciitis: rapidly progressive group a streptococcal infection secondary to deep palmar abscess.

摘要

CASE REPORT A 54-year-old homeless Hispanic man presented with complaints of fever and right upper extremity pain, erythema, and swelling for 1 day. Four days before admission, the patient noticed a small puncture wound on the palmar aspect of his right hand. The initial lesion, located at the distal portion of the patient's third metacarpal, had been caused by an unknown mechanism. Over the last 24 h, erythema, edema, and pain rapidly progressed up the arm and were quickly followed by fever and bullae formation. The patient had no significant past medical history, was taking no medications, and had no known drug allergies. He was unable to recall the timing of his last tetanus booster but had received his primary immunization series. Although the patient had abused cocaine and alcohol in the past, he denied a history of i.v. drug use, diabetes mellitus, or human immunodeficiency virus (HIV).