NECROTIZING FASCIITIS OF THE RETROPERITONEUM - AN UNUSUAL PRESENTATION OF GROUP-A STREPTOCOCCUS INFECTION

A 14-year-old girl presented with symptoms resembling acute appendicit is. Five days after appendectomy and continued fever and severe abdomi nal pain, blood cultures were found positive for Streptococcus pyogene s. Two days later a diagnosis of group A streptococcal peritonitis wit h necrotizing retroperitoneal fasciitis was confirmed by retroperitone al cultures obtained at laparotomy. Although multiple organ systems sh owed impaired functioning, including hepatic, renal and respiratory ch anges, she did not meet the criteria for streptococcal toxic shock syn drome. She was treated with a combination of high-dose parenteral peni cillin and clindamycin, followed by prolonged treatment with clindamyc in orally. Recovery was complicated by persistent hydronephrosis, whic h was slow to resolve.