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Potentially life-threatening emergency
Necrotizing fasciitis in Child
See also in: Cellulitis DDx,External and Internal Eye
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Necrotizing fasciitis in Child

See also in: Cellulitis DDx,External and Internal Eye
Contributors: Samantha R. Pop MD, Keith Morley MD, Noah Craft MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Emergent Care / Stabilization:
The mortality of necrotizing fasciitis is high. Treatment includes broad-spectrum intravenous (IV) antibiotics and immediate surgical debridement of infected and devitalized tissue. Therefore, if you are considering this diagnosis, stop reading this and contact a surgeon now.

Diagnosis Overview:
Necrotizing fasciitis is a deep and often devastating bacterial infection that tracks along fascial planes and expands well beyond any outward cutaneous signs of infection (eg, erythema). It may be classified as polymicrobial (type 1) or monomicrobial (type 2). Type 1 infections are caused by aerobic and anaerobic organisms and generally affect hosts who are immunocompromised, those with underlying illness (such as diabetes mellitus), and elderly patients. Type 2 infections are most commonly caused by Streptococcus pyogenes, although they can be caused by methicillin-resistant Staphylococcus aureus (MRSA); they can occur in healthy individuals with no past medical history.

In the pediatric population, type 2 (monomicrobial) infections are much more common than type 1 (polymicrobial) infections.

Streptococcus species, particularly S pyogenes, and MRSA are equally found to be the most common causative organisms involved in the pediatric population, followed by Pseudomonas aeruginosa. An increase in invasive S pyogenes (invasive group A strep [iGAS]) infections in children, including necrotizing fasciitis and streptococcal toxic shock syndrome, has been reported in Europe and the United States in 2022-2023.

Necrotizing fasciitis can occur without a clear portal of entry, although predisposing risk factors in the pediatric population include blunt and penetrating trauma, general infectious conditions, and breaches in the skin and mucosa (eg, lacerations, varicella vesicles, penetrating wounds, dog or insect bites, chronic skin conditions, and surgical wounds).

Patients with necrotizing fasciitis are acutely ill. They are often thought to have cellulitis that is not responding to standard antibiotic therapy. There is commonly a paucity of cutaneous findings in the early course of the disease. Pain is out of proportion to physical findings, although this may not be present in the pediatric population. There may be associated skin necrosis and bullae formation. Signs of systemic illness such as fever, lethargy, hypotension, and tachycardia are present; these may progress to multiorgan failure.

When necrotizing fasciitis is localized to the lower abdominal wall, perineum, or genitals, it is known as Fournier gangrene. Diabetic patients are particularly susceptible to Fournier gangrene, which is often polymicrobial with mixed anaerobic organisms.


M72.6 – Necrotizing fasciitis

52486002 – Necrotizing fasciitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

It can sometimes be difficult to differentiate necrotizing fasciitis from Pyoderma gangrenosum (PG). This is especially true in the pustular variant of PG that may not develop into frank ulceration. Relatively rapidly progressing soft-tissue inflammation not responding to broad-spectrum antibiotics and surgical debridement should be promptly evaluated by a dermatologist to rule out PG.

Also consider:
  • Cellulitis
  • Calciphylaxis
  • Subcutaneous Acute febrile neutrophilic dermatosis (subcutaneous Sweet syndrome)
  • Ecthyma gangrenosum
  • Erysipelas
  • Deep vein thrombosis
  • Purpura fulminans complicating varicella
  • Insect bite (eg, Recluse spider envenomation)
  • Vasculitis
  • Disseminated intravascular coagulation
  • Staphylococcal scalded skin syndrome
  • Toxic shock syndrome
  • Vibrio vulnificus infection

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:04/29/2019
Last Updated:04/06/2023
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Necrotizing fasciitis in Child
See also in: Cellulitis DDx,External and Internal Eye
A medical illustration showing key findings of Necrotizing fasciitis : Fever, Bullae, Edema, Erythema, Pain out of proportion to exam findings, Ecchymosis
Clinical image of Necrotizing fasciitis - imageId=4708490. Click to open in gallery.  caption: 'An eschar with surrounding erosion and crusting at the ankle.'
An eschar with surrounding erosion and crusting at the ankle.
Copyright © 2024 VisualDx®. All rights reserved.