Necrotizing fasciitis, also known as flesh-eating disease, is a rapidly progressive bacterial infection of the subcutaneous tissue. Prompt recognition is potentially lifesaving, but early identification can be challenging given the lack of skin findings in the first 24 hours of infection. Therefore, the pediatrician needs a high index of suspicion.

Necrotizing fasciitis is rare in children compared with adults. The incidence in children is 0.08 to 0.13 per 100,000 per year, with a case fatality of 10%, compared with 0.4 per 100,000 per year in adults, with fatality ranging from 25% to 75%. Males are affected slightly more commonly than females. Although it can affect any part of the body, most infections in children affect the trunk and lower extremities.

A sudden onset of severe pain out of proportion to the cutaneous signs is the hallmark of necrotizing fasciitis. The infection typically spreads along the muscle fascia, with its relatively...

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