Necrotizing fasciitis due to a methicillin-sensitive Staphylococcus aureus isolate harboring an enterotoxin gene cluster

Abstract

Benign papular eruption on the left leg of a 72-year-old diabetic man developed into rapidly spreading necrotizing fasciitis despite antimicrobial therapy and surgical debridements. This led to eventual amputation to control the infection. The etiological agent was a Staphylococcus aureus isolate harboring the enterotoxin gene cluster seg, sei, sem, sen, and seo but lacked all common toxin genes, including Panton-Valentine leukocidin.

FIG. 1.

(a) Appearance of the left leg on admission to the hospital. There is extensive erythema and purpura involving the entire left leg. Edema is present outside the area of erythema, and necrosis is developing along the medial aspect of the thigh. (b) Extensive necrosis of the leg. The infection rapidly progressed to frank necrosis of the skin and subcutaneous tissues, necessitating surgical debridement. (c) Histological appearance of deep subcutaneous tissue from surgical debridement. There is a dense inflammatory infiltrate of neutrophils, lymphocytes, and macrophages. A bacterial colony is present within the tissue (arrow). (d) Appearance of the left leg after two surgical debridement procedures. After extensive debridement the wounds were grafted with porcine skin. Despite continued antibiotic therapy his condition worsened and the patient required an above-the-knee amputation.