A Case of Necrotizing Fasciitis due to Group G Streptococcus with Amputation Avoided of the Affected Limb

Case Report

Austin Crit Care Case Rep. 2021; 5(2): 1027.

A Case of Necrotizing Fasciitis due to Group G Streptococcus with Amputation Avoided of the Affected Limb

Hirayama K¹, Kuroshima T¹, Okada M¹*, Nakayama M¹, Miyano E¹, Sugawara M², Hayashi K², Horikoshi Y¹, Kawata D¹, Takauji S¹, Kokita N¹, Yamamoto AI² and Fujita S¹

¹Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan

²Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan

*Corresponding author: Motoi Okada, Department of Emergency Medicine, Asahikawa Medical University, 078-8510, Midorigaoka Higashi 2-1-1-1, Asahikawa, Japan

Received: April 12, 2021; Accepted: May 07, 2021; Published: May 14, 2021


Group G Streptococcus (GGS) causes toxic shock syndrome. Its incidence has been increasing in the elderly in recent years.

The case is a female patient in her 60s, with rheumatoid arthritis, who developed necrotizing fasciitis in her right thigh. We administered antibacterial agents and debridement frequently at an early stage, followed by aggressive high-protein enteral nutrition and multidisciplinary treatment. During the course of treatment, the patient’s general condition temporarily deteriorated because of fecal contamination. We considered amputation of the lower limb and implantation of a stoma, but finally succeeded in preserving the limb by performing two skin grafts. The patient was able to walk and was discharged on day 66.

GGS infection is a risk factor for elderly patients with underlying diseases such as malignancy or immunocompromised states. When necrotizing fasciitis due to fulminant streptococcal infection develops in a proximal limb, amputation of the limb is often necessary to save the patient’s life. In this case, a fulminant GGS infection developed in an immunocompromised patient with active rheumatoid arthritis. Although the risk of limb amputation was high, multidisciplinary treatment enabled functional preservation of the affected limb.

Keywords: GGS; STSS; Necrotizing fasciitis; Fulminant streptococcal infections


GGS: Group G Streptococcus; GAS: Group A Streptococcus; qSOFA: quick Sequential Organ Failure Assessment; ICU: Intensive Care Unit; CHDF: Continuous Hemodiafiltration


Necrotizing fasciitis is a rapid-spreading, necrotizing soft tissue infection, with the shallow fascia as the main site of bacterial infection. GGS derives from the normal bacterial flora of the human upper respiratory tract, and is endemic to the skin, gastrointestinal tract, and female genital tract. It has been implicated in endocarditis, septic arthritis, osteomyelitis, fetal infections, and meningitis.

GGS has genomic homology with Group A Streptococcus (GAS). Like GAS, it is thought to cause streptococcal toxic shock syndrome. Currently, GGS infections are attracting attention because of the increasing number of elderly people affected. Necrotizing fasciitis caused by GGS requires early therapeutic intervention. However, there are few reports on the prognosis of necrotizing fasciitis caused by GGS alone or of the amputation rate of affected limbs.

Case Presentation

The patient is a female in her 60s. She had been taking methotrexate, tocilizumab, and iguratimod for the treatment of rheumatoid arthritis. One day, she scraped her right heel and later visited a dermatologist. She was treated for cellulitis but became feverish, had swelling of the right thigh and difficulty walking; she was admitted to a nearby hospital. Subsequently, the swelling worsened and extensive redness and blood blisters appeared. She was suspected of having necrotizing fasciitis and was referred to our hospital for further evaluation and treatment.

On admission, there was no disturbance of consciousness, body temperature was 37.50C, heart rate was sinus tachycardia 124 bpm, blood pressure was 84/40 mmHg, respiratory rate was 30 tachypneas, and the quick Sequential Organ Failure Assessment (qSOFA) score was 2 points. Physical examination of the chest and abdomen showed no abnormal findings. However, there was spontaneous pain and tenderness on the right thigh, accompanied by redness, swelling, and blister formation. In addition, a crusting with exudate was observed on the right heel (Figure 1).