Hidalgo-Carballal A, Suárez-Mier M P
Institute of Legal Medicine of Albacete, Cuenca y Guadalajara, Tarancon, Cuenca, Spain.
Am J Forensic Med Pathol. 2006 Mar;27(1):93-6. doi: 10.1097/01.paf.0000203152.62134.1f.
A 4-year-old child with chickenpox infection for 5 days prior to death complained of swelling and pain in his right leg that required medical assistance in the emergency department. Radiologic study was normal, and analgesic and bandage of the leg were prescribed. Some hours later, he presented cyanosis, dizziness, and vomiting and collapsed. A complete forensic autopsy was performed 12 hours after death. External examination of the body showed numerous crusty varicella skin lesions, especially over the trunk, and swelling and reddening of his right leg. The brain was swollen, with cerebellar herniation, and both adrenal glands were hemorrhagic.Microscopically, neutrophilic infiltration and muscle fiber necrosis were observed in soft tissues of his right leg, and fibrin microthrombus were numerous in capillaries of the plexus choroideus, larynx, lungs, and adrenals. Bacterial emboli were present in most of the tissues. Microbiologic cultures of blood and cerebrospinal fluid showed group A beta-hemolytic streptococcus (Streptococcus pyogenes). Death was attributed to fulminant streptococcal toxic shock syndrome, with necrotizing fasciitis as a complication of varicella.
一名在死亡前5天感染水痘的4岁儿童，抱怨右腿肿胀疼痛，在急诊科寻求医疗救助。影像学检查正常，遂开具了腿部止痛和包扎处理。数小时后，他出现发绀、头晕、呕吐，随后昏迷。死亡12小时后进行了完整的法医尸检。尸体外部检查显示有大量结痂的水痘皮肤病变，尤其是在躯干上，右腿肿胀发红。脑部肿胀，伴有小脑疝形成，双侧肾上腺出血。显微镜下，在右腿软组织中观察到中性粒细胞浸润和肌纤维坏死，脉络丛、喉部、肺部和肾上腺的毛细血管中有大量纤维蛋白微血栓。大多数组织中存在细菌栓子。血液和脑脊液的微生物培养显示为A组β溶血性链球菌（化脓性链球菌）。死亡原因是暴发性链球菌中毒性休克综合征，坏死性筋膜炎为水痘的并发症。
