The Chennai based SIMS (SRM Institutes for Medical Science) Hospitals, Vadapalani, one of the leading super speciality quaternary care hospitals in Tamil Nadu, in a rare kind of clinical scenario, saved the life of a 9-year-old boy from a rare, but aggressively fatal bacterial infection, Necrotising Fasciitis.
Necrotising Fasciitis is a rare medical condition and the complications are very serious. Characterized by a rapid destruction of the tissue, the diagnosis of the condition can be difficult due to lack of definitive signs & symptoms and acting fast is the key. With Biopsy, Blood tests and Medical Imaging being the modalities for diagnosis, Necrotising fasciitis, if diagnosed in early stages and treated well on time, can be arrested from progressing faster internally and save the patient from multiple organ failure. Typically, antibiotic IV and surgery are the first line of treatment in these cases and in more serious cases the patients may undergo blood transfusion too.
The 9-year-old boy from Nellore presented with a huge swelling of the left leg, which had developed due to an unknown injury that he sustained, while playing in the backyard of his house. On initial evaluation the injury seemed like a normal wound, but gradually progressed into a swelling, going up to the knee causing a blackish discolouration. Moreover, the boy was not able to walk due to the debilitating pain inflicted by the injury and was taken to a nearby hospital for further investigation, and was provided some native treatment. With elapsing of time his condition became more critical and he was referred to SIMS Hospitals, Chennai.
On admission to the Paediatric Intensive Care Unit and further examination, it was noticed that the boy’s leg had a severe bacterial infection of tissue (Necrotising Fasciitis). Considering a possibility of snake bite, the doctors immediately administered him an ASV (Anti-snake venom). Owing to severe infection, the boy had also developed several other complications like rhabdomyolysis (muscle breakdown), haematuria (blood in urine), renal dysfunction and myocardial dysfunction. His third and fourth toes were also noticed to have developed gangrene.
Dr. Shrishu Kamath – Senior Consultant – Paediatric ICU – SIMS Hospital
Speaking about the successful treatment, Dr. Shrishu Kamath – Senior Consultant, Paediatric ICU, SIMS Hospital said, “The case was quite challenging considering the fact that the boy had to be treated immediately for compromised internal organs, along with saving his limb from amputation. A team of doctors consisting of plastic surgeons and a vascular surgeon, swung into action and intervened to carry out an emergency fasciotomy, following which the boy was put under observation of the Paediatric Intensive Care team for a period of over one week. After his internal health stabilized, a skin grafting was done on his leg, post which he healed well and was discharged after a few days. On reviewing after 21 days the boy has recovered well and is doing fine.”
Commenting on the case Dr. Raju Sivasamy – Vice President, SIMS Hospital, said, “Superior Intensive care support is very critical when dealing with children with necrotising fasciitis.It requires special expertise and our Paediatric ICU prides of highly trained and well qualified paediatricians, nurses and technicians, who, ably supported by other multi-disciplinary team of specialists, provide the best care for children needing critical care support. Our six-bedded Paediatric ICU is one of the best in the city, and is equipped with the most modern technology, which can monitor both invasive and non-invasive parameters.“