Ibuprofen
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Group B streptococcal necrotising soft-tissue infection: case report A 49-year-old man developed group B streptococcal necrotising soft-tissue infection during treatment with ibuprofen [dosage, route, indication, duration of treatment to reaction onset not stated]. The man with uncontrolled type 2 diabetes mellitus was referred to the hospital for febrile painful erythematous and swelling left leg along with a necrotic and hypo-aesthetic area. Necrotising soft-tissue infection (NSTI) was suspected. He received NSAID i.e. ibuprofen before 3 days. He never had cutaneous portal of entry, sign of impaired perfusion, skin trauma or history of drug abuse. At admission, lab tests showed an inflammatory syndrome with CRP level of 380 mg/L and leucocytes 9100 /mm3. NSTI was confirmed following an emergency surgical debridement of necrotic tissues. The man received empirical IV antibiotic therapy with clindamycin and piperacillin/tazobactam for 14 days postoperatively. The biological and clinical evolution had been favourable with complete healing following thin skin graft. Subcutaneous puncture and intraoperative biopsy cultures were positive for monomicrobial group B streptococcus (GBS). His blood cultures were found to be negative. Cultures of anal and oropharyngeal swabs were also positive for GBS. Control anal and oropharyngeal swabs turned out negative after 2 years. The 4 isolates were wholegenome sequenced and compared by core genome multilocus sequence typing (MLST). Disc-diffusion antibiotic susceptibility testing of all isolates were performed, which showed isolated resistance to tetracycline. All four strains belonged to the sequence type 4 (ST4) MLST type (CC3 clonal complex) and were considered identical. Beta-haemolytic streptococci (BHS) usually involved in NSTIs were group A streptococcus (GAS), but GBS was an emerging aetiology. Thus, group B streptococcal necrotising soft-tissue infection was considered. Charpentier C, et al. Group B streptococcal necrotizing soft-tissue infection: role of pharyngeal and perineal carriage. Journal of the European Academy of Dermatology and 803507535 Venereology : 15 Sep 2020. Available from: URL: http://doi.org/10.1111/jdv.16943
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Reactions 17 Oct 2020 No. 1826
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