ARDS following flexor sheath infection: a case report
Received: 26 July 2010 / Accepted: 18 September 2010 / Published online: 30 September 2010
In a plastic surgery setting, adult respiratory distress
syndrome (ARDS) is most commonly seen in a major
burns setting. ARDS is associated with 40% [1, 2]
mortality. The aetiology of ARDS varies but there are few
reports secondary to group A Streptococcus [1, 3].
We present a case of a 30-year-old male who presented
with a finger infected with group A Streptococcus and
subsequently developed ARDS secondary to this infection.
A 30-year-old right-hand-dominant male was admitted to the
plastic surgery department with a 2-day history of swollen
right index finger. There was no history of trauma and he was
previously fit and well, although a smoker. He was admitted
for intravenous antibiotics and washout of the flexor sheath in
the operating room. Following persistent infection in the
finger, the patient underwent a further washout and finally
amputation of the finger. He continued on IV meropenem and
clarithromycin, following a rash with penicillins. The follow-
ing morning, the patient’s hand was clinically much improved.
Microbiology confirmed growth of group A Streptococcus
from the hand. Subsequently, the patient complained of
shortness of breath but no productive cough. He was
haemodynamically stable with no signs of systemic sepsis,
respiratory rate 20 breaths per minute and maintained oxygen
saturations of 95% on 5 L O
but desaturated rapidly on
weaning oxygen. Blood gases showed PO
of 16 on 5 L O
Examination of chest showed bilateral mid and lower zone
crepitations. Chest X-ray showed extensive bilateral diffuse
opacification (Fig. 1).
The patient was diagnosed with ARDS and transferred to
high dependency unit (HDU) for continuous positive
airway pressure ventilation. His respiratory condition
slowly improved. The hand remained clean and the wound
was directly closed a week later.
Early identification of ARDS, and awareness of it occurring
secondary to group A streptococcal infections, allowed this
patient to be transferred to HDU early and supported in the
short time prior to severe deterioration.
Fig. 1 Chest X-ray result showing extensive bilateral diffuse
K. Edmonds (*)
Department of Plastic and Reconstructive Surgery,
St George’s Hospital,
Eur J Plast Surg (2012) 35:193–194