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