Jia Xiao-Ling, Pathak Janak L, Tong Jin-Fa, Su Ji-Mei
Department of Stomatology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310007, Zhejiang, China.
Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatological Hospital of Guangzhou Medical University, Guangzhou, 510140, China.
BMC Pediatr. 2018 Jun 22;18(1):198. doi: 10.1186/s12887-018-1177-9.
Hemolytic streptococcus gangrene is a life threatening invasive bacterial infection. Hemolytic streptococcus gangrene in the danger triangle of the face is too lethal to operate. A case of the confirmed hemolytic streptococcus gangrene in the danger triangle of the face caused by Group A beta-hemolytic streptococcus (GAS) in 20-months old boy is presented to draw attention of clinicians to this uncommon but frequently fatal infection.
Previously healthy 20 months old boy suddenly developed paranasal gangrene on the left side of the danger triangle of the face, followed by rapidly progressive thrombocytopenia and hepatitis. The clinical features, liver function, and hematological and serological parameters resembled to a description of streptococcal toxic shock syndrome (STSS). Aggressive antibiotics, substitutional and supportive therapy were conducted without surgical debridement of facial tissues. Prompt diagnosis and aggressive timely treatment completely cured the disease in 28 days.
The present case report demonstrates prompt diagnosis and timely treatment as a strategy to cure the fatal hemolytic streptococcus gangrene located in too risky body part to operate.
溶血性链球菌坏疽是一种危及生命的侵袭性细菌感染。面部危险三角区的溶血性链球菌坏疽因过于致命而无法进行手术。本文报告一例20个月大男孩由A组β溶血性链球菌（GAS）引起的面部危险三角区确诊溶血性链球菌坏疽病例，以引起临床医生对这种罕见但常致命感染的关注。
一名此前健康的20个月大男孩突然在面部危险三角区左侧出现鼻旁坏疽，随后迅速出现进行性血小板减少和肝炎。临床特征、肝功能以及血液学和血清学参数与链球菌中毒性休克综合征（STSS）的描述相符。在未对面部组织进行手术清创的情况下，给予了积极的抗生素治疗、替代治疗和支持治疗。及时诊断并积极治疗使疾病在28天内完全治愈。
本病例报告表明，对于位于手术风险过高身体部位的致命性溶血性链球菌坏疽，及时诊断和治疗是治愈该病的策略。
