Necrotizing Fasciitis Complicating Chickenpox in a Pediatric Patient: Successful Treatment with Adjunctive use of Fresh Frozen Plasma (FFP) Plus Heparin

Abstract

Introduction: Necrotizing fasciitis (NF) is a rare but life-threatening soft tissue infection characterized by rapid necrosis of the fascia and surrounding tissues. It often requires prompt recognition and aggressive treatment to prevent severe outcomes. Necrotizing fasciitis can occur as a complication of various infections, including chickenpox, particularly in pediatric patients. Case Presentation: We present the case of a 7-year-old boy who developed NF following chickenpox. The patient initially presented with fever, malaise, and spreading erythematous lesions over the neck, trunk, and extremities. These lesions rapidly progressed to the left facial, neck, and thorax regions, resulting in tissue necrosis and systemic toxicity. Prompt recognition and aggressive surgical debridement were initiated, along with broad-spectrum antibiotics and early infusion of intravenous immunoglobulin (IVIG). Despite these measures, the patient’s condition continued to deteriorate, prompting the adjunctive use of a combination of fresh frozen plasma (FFP) plus heparin. This therapeutic intervention resulted in a dramatic improvement in the patient’s clinical status. Conclusions: This case highlights the potential role of FFP plus heparin in the management of NF complicating varicella infection in pediatric patients. The combination therapy may offer a valuable adjunctive treatment option when conventional measures are insufficient, underscoring the need for further research into its efficacy and safety in similar clinical scenarios.