NECROTIZING fasciitis due to group A β-hemolytic streptococci, though rare, continues to present problems in diagnosis and management and continues to be associated with an alarmingly high mortality rate. The high mortality and morbidity are probably a result of failure to recognize pathognomonic features which allow early diagnosis.1
One of the earliest reports of the disease, described as "hospital gangrene," came from the Civil War. The skin of affected parts was described as turning green, blue-gray, or black, and virtually melting away. The official records cite 2,642 cases, of which 1,142 (46%) proved fatal.2
Before the widespread use of modern methods of bacterial identification, streptococcal necrotizing fasciitis was confused with other types of gangrene. According to White,3 one of the first cases to be supported by bacteriologic studies was reported as "necrotizing erysipelas" by Pfanner in 1918 and was shown to be caused by β-hemolytic streptococci.