Necrotizing fasciitis: An unusual presentation

A previously healthy 41-year-old woman was admitted with fever of 3 days' duration, marked jaundice, and hepatosplenomegaly. The tentative diagnosis was hepatitis, probably viral. Soon afterwards, a full-blown picture of streptococcal septicemia with right foot gangrene appeared and the diagnosis of hemolytic streptococcal gangrene was made. This case is exceptional for two reasons: the cause was suspected to be pumice stone, applied several days previously for cosmetic purposes (removal of keratotic tissue from the foot). No such complication from the use of pumice stone has been reported. The second reason is that this mode of presentation with fever and deep jaundice has occasionally been reported, mostly in septic debilitated patients, with gram-negative bacteremia. However, it is extremely rare in previously healthy patients and preceding streptococcal gangrene. The patient survived following prompt surgical debridement and antibiotic therapy. Early diagnosis and treatment of hemolytic streptococcal gangrene are crucial; otherwise the prognosis is poor.