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Picture of the Month

Ann M. Kosloske, MD; Murray Feingold, MD
Am J Dis Child. 1983;137(11):1115-1116. doi:10.1001/archpedi.1983.02140370075023.
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Denouement and Discussion 

Necrotizing Fasciitis 

Manifestations  Necrotizing fasciitis is a rare, virulent infection of soft tissue that occurs in adults and children. Approximately half of the pediatric cases have occurred in neonates. The infection may be associated with an unsterile delivery, circumcision or other operations, and trauma. It may also occur secondary to a focal infection, such as a breast abscess. In some patients, no predisposing factor is identified.The infection, which spreads rapidly along fascial planes, is associated with severe edema and necrosis of the overlying skin. The characteristic appearance is a central patch of purple-black skin discoloration surrounded by erythema. Although crepitation of the wound is common in adults, it is rarely present in children. Systemic toxicity is manifested by tachycardia, diaphoresis, hypotension, mottling of the skin, and lethargy or irritability. Fever is uncommon. Older children complain of extreme pain that is out of proportion to the apparent


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