Necrotising fasciitis (NF) is a rapidly progressive life-threatening soft tissue infection. NF is uncommon in children and paediatric cases of chest wall NF are particularly rare. Diagnosis of NF is challenging as early clinical features are non-specific and the precipitating event may appear trivial. A delay in diagnosis and treatment is associated with significant morbidity and mortality. We present a case series of two children who were recently treated at the Royal Hobart Hospital for necrotizing fasciitis of the chest wall after minor trauma.
A 13 year old male presented to the Emergency Department with left chest wall and axillary pain, nausea, vomiting and diarrhea. He also reported a history of minor impact into a handrail on a bus. He was discharged home with a diagnosis of gastroenteritis and musculoskeletal pain. The following day, he re-presented in septic shock. An ultrasound to exclude septic arthritis of the shoulder prompted a CT scan of the chest wall. This demonstrated features of NF. A 4 year old boy was referred by a GP with left pectoral pain and swelling, fevers and general malaise. The patient also reported a fall from standing height two days prior to onset of symptoms. He had no bruising, abrasions or any other external signs trauma. A bedside ultrasound led to an MRI of the chest wall which showed features suspicious for necrotizing fasciitis.
NF of the chest wall after minor trauma is rare in children. To the best of our knowledge, only five other cases of NF of the chest wall following minor trauma in children have been reported. We hope that this presentation will increase the index of suspicion of NF and reduce associated morbidity and mortality.