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BJA Advance Access originally published online on January 22, 2004
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British Journal of Anaesthesia, 2004, Vol. 92, No. 3 427-429
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Reports

Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block

S. Nseir*, P. Pronnier, S. Soubrier, T. Onimus, F. Saulnier, D. Mathieu and A. Durocher

Service de Réanimation Médicale, Hôpital Calmette, CHRU, boulevard du Pr. Leclercq, F-59037 Lille cedex, France

*Corresponding author. E-mail s-nseir@chru-lille.fr

A 74-yr-old diabetic woman developed necrotizing fasciitis of the right upper limb after axillary brachial plexus block for carpal tunnel decompression. Clinical signs included oedema, diffuse swelling and bullae; rapidly followed by toxic shock syndrome and multiorgan failure. The patient died 48 h after hospital admission, despite broad-spectrum antibiotics, surgical treatment and supportive measures for the management of shock and multiorgan failure. Cultures yielded group A Streptococcus. Delay in antibiotic and surgical treatment probably affected the outcome. Early diagnosis and treatment are essential to improve the outcome of streptococcal necrotizing fasciitis.

Br J Anaesth 2004; 92: 427–9


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