Skin and Soft Tissue Infection as a Complication of Varicella Infection Ended up in Using Intravenous Immunoglobulin Instead of Surgical Debridement: A Case Report and Short Review of Literature

Varicella infection is a vaccine-preventable infection, which can result in different complications. Necrotizing fasciitis (NF) as a skin and soft tissue infection is a rare complication of varicella infection in childhood. Early diagnosis and treatment of necrotizing fasciitis can save life. Surgical debridement along with appropriate antimicrobial treatment is very common. However, some patients cannot undergo surgeries and physicians should try other options.
A 6-year-old male with a history of chicken pox infection was admitted due to abdominal pain and fever. On physical examination, abdominal tenderness and diffused erythema on the entire abdomen as well as crepitation was prominent. As acute abdomen was ruled out by abdominal sonography, the patient received antimicrobial treatment, which was ineffective. Meanwhile, his hemodynamic condition worsened and sign of scaly skin presented, antimicrobial regimen was changed and surgical consultation was ordered. Unfortunately, surgical debridement was impossible due to extensive tissue involvement. Intravenous immunoglobulin (IVIG) was initiated and patient was transferred to the intensive care unit (ICU). Within 72 hours of administering IVIG, skin erythema and abdominal pain decreased and on the 10th day of admission, the patient became afebrile and healthy. Antibiotics were discontinued on the 12th day and the patient was discharged in good conditions.
Although tissue debridement is the cornerstone to treat necrotizing tissue infection, in some cases patients might benefit from adjuvant treatments such as IVIG. Although this treatment cannot be generalized to every patient, it may be concluded that physicians can save surgical options and try IVIG under close clinical observation to avoid possible multiple surgical debridement.