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Necrotizing Fasciitis and Death Following an Insect Bite

Fernando, Dinesh Malcolm G. MBBS, MD, DLM, DMJ(Lond)*; Kaluarachchi, Chandishni I. MBBS*; Ratnatunga, Champa N. MBBS

American Journal of Forensic Medicine & Pathology: September 2013 - Volume 34 - Issue 3 - p 234–236
doi: 10.1097/PAF.0b013e3182a18b0b
Case Reports

Abstract: A healthy man who presented to hospital with painful swelling of the left arm following a history of insect (tick) bite developed shock and died within 48 hours. The postmortem examination revealed swelling and desquamation of skin and erythema on the left arm extending below the elbow. The subcutaneous tissue was necrotic with healthy underlying muscles. Group A β-hemolytic streptococcus was isolated from postmortem swabs of the infected tissue. Histopathologic changes were consistent with necrotizing fasciitis.

Secondary bacterial infection is an important possible complication following insect bite, and a high degree of suspicion with aggressive early treatment is required in cases of necrotizing fasciitis to prevent fatalities. Both clinicians and pathologists need to be aware of this rare, rapidly fatal condition that may follow an insect bite.

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From the Departments of *Forensic Medicine; and †Microbiology, Faculty ofMedicine, University of Peradeniya, Kandy, Sri Lanka.

Manuscript received November 1, 2012; accepted February 22, 2013.

The authors report no conflicts of interest.

Reprints: Dinesh Malcolm G. Fernando, MBBS, MD, DLM, DMJ(Lond), University of Peradeniya, Kandy, Sri Lanka. E-mail:

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© 2013 by Lippincott Williams & Wilkins.