Group A streptococcus is responsible for a diverse range of
soft tissue infections. Manifestations range from minor oropharyngeal and cellulitic skin
infections to more severe conditions such as
necrotizing fasciitis and
septic shock. Troubling increases in the incidence and the severity of
streptococcal infections have been reported over the past 25 years. Cases of streptococcal
necrotizing fasciitis have received significant attention in the literature, with prompt surgical
debridement being the mainstay of treatment. However, cases of rapidly progressing upper extremity streptococcal
cellulitis leading to
shock and a subsequent surgical intervention have not been well described. This article presents a case of an 85-year-old woman with a rapidly progressing, erythematous, painful, swollen hand associated with
fever,
hypotension, and mental status change. Due to a high clinical suspicion for
necrotizing fasciitis, the patient was rapidly resuscitated and underwent immediate surgical irrigation and
debridement. All intraoperative fascial pathology specimens were negative for
necrotizing fasciitis, leading to a final diagnosis of Group A streptococcal
cellulitis. Although surgical intervention is not commonly considered in patients with
cellulitis, our patient benefited from irrigation and
debridement with soft tissue
decompression. In cases of
necrotizing fasciitis as well as rapidly progressive
cellulitis, prompt diagnosis and aggressive treatment may help patients avoid the catastrophic consequences of rapidly progressive
group A streptococcal infections.