Aim An 8-year-old child was admitted from a rural hospital. She presented with cutaneous symptoms of varicella in addition to a week of upper respiratory tract symptoms. She was admitted to the hospital after a varicella eruption surrounded by a 5x5 cm hyperemic yard grew to the size of a man’s palm. An ultrasound scan revealed phlegmone.

Material and Method After obtaining a blood culture (BC), intravenous (IV) ceftriaxone was started, and then the febrile child with elevated inflammatory parameters was referred to our hospital for surgical care.

Results On admission, the child with a negative medical history had varicella eruptions of various stages all over the body. Purplish-greenish hematomas the size of two man’s palm and a 4x5 cm area of epithelial detachment were seen on the right hip. Therapy was supplemented with oral acyclovir and IV clindamycin. During the night, fever, bilateral non-purulent conjunctivitis and strawberry tongue appeared. The next morning she was seen by a dermatologist and a surgical consultation was repeated. She was admitted to the Intensive Care Unit (ICU) due to fluid-refractory hypotension. Surgical exploration and necrectomy were performed on the second day. On the third day she underwent a second surgical exploration and necrectomy. Streptococcus pyogenes was cultured from the first BC, and the toxin determination showed pyrogenic A exotoxin. S. pyogenes was cultured as well from the sample taken from the surgical site. The child required mechanical ventilation for 2 days in the ICU, was nursed for a total of 4 days, and then transferred to our surgical department. She was treated with intermittent vacuum therapy for 18 days followed by skin grafting.

Conclusions With our presentation we would like to raise awareness about varicella associtaed necrotizing fasciitis and its early recognition!