Necrotizing fasciitis in adolescents with poorly controlled type 1 diabetes mellitus: report of two cases

Abstract

Necrotizing fasciitis (NF) is a potentially fatal bacterial infection of the subcutaneous soft tissues. Two cases of polymicrobial NF in adolescents with type 1 diabetes mellitus and poor glycemic control are reported. The perineal region was involved in both cases. One case was precipitated by apparently minimal trauma, the other by high-impact trauma. Diabetes mellitus has been identified as a common comorbidity and predictor of increased mortality in adult patients with NF. The associations between diabetes and the incidence or outcome of NF in children and adolescents are not known. In all cases, early identification and aggressive surgical intervention are important for limiting morbidity and mortality.

Juvenile, insulin‐dependent diabetes mellitus, type 1‐related dermatoses

“…5). 123 Two cases of polymicrobial NF in adolescents with T1D and poor glycaemic control have been reported 124 . The perineal region was involved in both cases.…”

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review

“…Conwell et al. described 2 adolescents with poorly controlled T1DM who developed polymicrobial NF after different degrees of trauma involving the perineal region ( 112 ). Candida superinfection and surgical debridement have been reported in one case, and septic shock and suspected osteomyelitis in another.…”

“…Both patients required prolonged intravenous antibiotic treatment and correction of hypocalcemia complicating the infection. The paucity of cutaneous signs in the early stage of the disease together with intense pain even in absence of tissue damage, otherwise with a history of even mild trauma, should induce suspicion of NF ( 112 ).…”

“…It is rare in the pediatric age group, and Varicella-Zoster virus or Group A, b-hemolytic streptococcal infections seem to be predisposing factors. Conwell et al described 2 adolescents with poorly controlled T1DM who developed polymicrobial NF after different degrees of trauma involving the perineal region (112). Candida superinfection and surgical debridement have been reported in one case, and septic shock and suspected osteomyelitis in another.…”