Rapidly fatal necrotizing fasciitis: report of three cases

Necrotizing fasciitis is a rare but life-threatening soft tissue infection characterized by necrotizing process of the subcutaneous tissues and fascial planes, with resulting skin gangrene and systemic toxicity. We describe three fatal cases of clinically undiagnosed necrotizing fasciitis caused by Streptococcus pyogenes. In all cases, the evolution of disease was fulminant, and all patients were treated with non-steroidal anti-inflammatory drugs. Recently have been reported an association between using of this drugs with an increased incidence of fulminant evolution of necrotizing facciitis. The paper also highlighted the correlation between the histopathologic features of infected tissue with poor acute inflammatory response, and a high concentration of bacteria in infected tissue, which have been confirmed using Gram staining modified by Brown&Bremm. These presented cases emphasize the need for early diagnosis, because prompt clinically recognition prevents unnecessary morbidity and mortality.