Necrotizing Fasciitis Of The Upper Extremity

Description: Necrotizing Fasciitis of the Upper Extremity Resulting From a Water Moccasin Bite from Southern Medical Journal Posted 12/30/2002 Michael F. Angel, MD, Feng Zhang, MD, PhD, Matthew Jones, BS, James Henderson, MD, Stanley W. Chapman, MD Abstract and Introduction Abstract Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture. The patient was treated with antivenom, a diuretic regimen, broad spectrum antibiotics, and 18 separate surgical procedures. After the application of skin grafts, the wound completely healed. This case illustrates that a venomous snakebite may result in infection with A hydrophila and can cause severe necrotizing fasciitis. Early and aggressive surgical intervention should be implemented as soon as the necrotizing fasciitis is diagnosed.