Necrotizing fasciitis in an immunocompetent child with a recent history of varicella-zoster virus infection: A case report from a resource-limited setting.

Necrotizing fasciitis is a rare but life-threatening soft-tissue infection characterized by rapid progression, extensive tissue destruction, and high morbidity and mortality. Secondary bacterial infections may occur after varicella-zoster virus infection; however, the timing and clinical context are essential when interpreting causality. We report the case of an 8-year-old previously healthy girl who presented with high-grade fever, severe pain, and rapidly progressive necrotic soft-tissue infection involving the right leg and buttock. She had a documented history of chickenpox two months before presentation, with residual healed scars noted on examination. Given the prolonged interval and absence of active varicella lesions, a direct causal relationship between varicella and necrotizing fasciitis could not be confirmed. Laboratory investigations showed leukocytosis, severe anemia, hyponatremia, markedly elevated C-reactive protein, and a Laboratory Risk Indicator for Necrotizing Fasciitis score of 10, supporting a high-risk diagnosis. Wound culture grew Proteus mirabilis, an uncommon organism in necrotizing fasciitis, and treatment was guided by culture sensitivity. The patient improved following prompt supportive care, intravenous antibiotics, urgent surgical debridement, and continued wound management. This case highlights the importance of cautious interpretation of remote varicella history, early recognition of necrotizing fasciitis, timely surgical intervention, culture-guided antimicrobial therapy, and multidisciplinary care, particularly in resource-limited settings.