Necrotizing fasciitis after varicella infection in children: A case series

Introduction: Necrotizing fasciitis is a rare but serious complication that can occur in children with chickenpox, even in immunocompetent children. Prompt diagnosis and immediate surgical treatment are mandatory to avoid potentially fatal complications. Cases presentation: The first patient was an 8-year-old female who presented with a 3-day history of varicella infection. Clinical examination revealed general varicella-related exanthema with necrotizing fasciitis in the left groin. In addition to immediate parenteral antibacterial treatment, emergency surgical exploration was done within 3 hours of arrival to the emergency department. Wide surgical debridement was the initial treatment. Primary closure was achieved using a rectus abdominis myocutaneous (RAM) pedicled flap. The postoperative course was uneventful. The second patient was a 6-year-old male with a history of renal disease who presented with a 3-day history of varicella infection to our emergency department. The patient was in a poor general condition and was initially treated with antibiotics for presumed urosepsis. After approximately 2 hours, he developed clear signs of necrotizing fasciitis in the right hemiscrotum. Surgical debridement was immediately performed, but the patient eventually succumbed due to uncontrolled sepsis. Conclusion: Necrotizing fasciitis is a potential complication of patients with chickenpox. Emergent surgical debridement is mandatory.