Necrotizing Fasciitis of Scalp and Neck in Neonates

A term 3 kg hospital born neonate presented on day 9 of life with continuous high grade fever since day 2 of life. Baby developed progressive erythema and swelling of scalp, face and periorbital area with small scattered black patches for 5 days (Fig.1A). Complete blood count showed haemoglobin of 13.5 g/dL, total leukocyte count of 26,200/mm3 and platelet count of 71,000/mm3. Coagulogram, cerebrospinal fluid (CSF) analysis, HIV ELISA, blood culture, immunoglobulin profile, T and B-lymphocyte subsets and nitro-blue tetrazolium tests were in normal range. Contrast CT scan showed diffuse skin and subcutaneous thickening of face and neck. Baby was managed with vancomycin, meropenem and clindamycin. He developed clinical deterioration and multiple areas of gangrenous spots surrounded by inflamed edematous skin over right half of face and scalp. Ultrasonography of neck was suggestive of pyomyositis and NF. Figure 1: A) Showing cellulitis of face, scalp and neck with areas of cutaneous skin necrosis of case 1. B) showed areas of granulation tissue over the scalp and neck after antibiotic therapy.