From Olecranon Bursitis to Necrotizing Fasciitis

Olecranon bursitis, a relatively common disease, often presents as self-controlled, local inflammatory illness. In some cases, either secondary to the inflammation or primarily due to local trauma an infectious disease of the bursae might develop. Infected olecranon bursitis, i.e. septic bursitis, is treated either conservatively with oral antibiotics or in more severe cases, surgically with local bursae debridement and intravenous antibiotics, with excellent prognosis.

While group A streptococcus (GAS) most often associated with tonsillitis and skin infections, on few occasions, it might develop into an invasive soft tissue disease, more commonly known as necrotizing fasciitis. This rapidly progressive disease of the subcutaneous tissue and fascia can deteriorate further into Streptococcal Toxic-Shock Syndrome induced by the streptococcal toxins and has potentially high rates of morbidities and mortality.

We present the case of a healthy, 38 years old man, admitted to the emergency room in our institution due to posterior elbow swelling and mild fever. After being diagnosed with septic olecranon bursitis he was hospitalized for surgical debridement and drainage. Later that day, he deteriorated clinically, and underwent three urgent extensive surgical exposures of the upper limb within 12 hours due to suspected streptococcal necrotizing fasciitis and toxic shock syndrome. He was then treated in the extensive care unit due to septic shock but has rapidly recovered and within less than a fortnight , has regained a fully functioning limb and presented with normal hemodynamic and laboratory values.

This case illustrates the prompt need for surgical intervention when clinical suspicion combined with deteriorating hemodynamic status suggests a rapidly advancing soft-tissue infection. Although intra-operatively the deep tissues were only extensively edematous but viable, with hardly any signs of necrosis, we believe that the urgent exposure has reduced dramatically the toxicity of the infection and allowed full recovery with hardly any morbidity.