DISCUSSION
Around 47% of chicken pox infection occurs in the adult population,
with male predominance.4 In adult patients, there is
an increased rate of complications compared to the pediatric age
group.3 The central nervous system and soft tissue
infections are the most frequent complications of chickenpox
infection.1,2,4 In a recent study, 1.3% of chickenpox
infections were complicated into necrotizing fasciitis
(NF).5 NF is a rapidly progressing infection of the
fascial layer with delayed skin, subcutaneous, and muscle involvement
with systemic toxicity.3 NF is classified into 4
groups depending on the microbiological etiology. In our patient, it was
polybacterial, which is type1 NF. There are various risk factors for the
occurrence of NF reported in the literature.3 Although
our patient was immunocompetent without any comorbidities, she had a
chickenpox infection 2 weeks back, which was a risk factor for the
development of NF. Early diagnosis is key for better management of
NF.1, 3
The most important finding in the patient’s history is pain, which will
be much more intense than the local dermatological manifestations. The
tissue biopsy is the gold standard for the diagnosis of NF. The LRINF
(laboratory risk indicators for necrotizing fasciitis) score helps in
earlier diagnosis by differentiating NF from
cellulitis.1, 3 The management of NF is essentially
medical as well as surgical. Medical management includes early
antibiotic administration and organ supportive therapy, whereas surgical
management is earlier bold debridement of the necrotic
tissues.3, 6