Use of drotrecogin alfa in necrotizing fasciitis: a case report and pharmacologic review

Necrotizing fasciitis (NF) is a devastating subset of necrotizing soft tissue infections that requires prompt diagnosis and treatment. Although often occurring in patients with impaired host defense mechanisms (diabetes mellitus, systemic immunosuppression, malignancy, etc.), NF may also present in the immunocompetent following a cutaneous lesion or break. Patients with NF often progress to a systemic inflammatory response syndrome or multiorgan system failure that demands advanced critical care practices. We present a case of NF in an immunocompetent patient and the subsequent use of drotrecogin alfa (Xigris). A review of the pharmacologic treatment of streptococcal NF is included. The addition of drotrecogin alfa to operative debridement and penicillin G/clindamycin therapy may be a useful adjunct in the treatment of necrotizing fasciitis due to group A streptococcus.