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Ibuprofen Associated with Necrotizing Fasciitis During Chickenpox

Most children who have varicella have a benign course. However, serious complications such as necrotizing fasciitis (NF) from organisms such as group A streptococcus may develop. This case-control study looks at a suspected association between NF and ibuprofen use, as well as other risk factors.

Over a 19-month period, 19 children were hospitalized with NF within three weeks of primary varicella infection. Twenty-nine children hospitalized at the same institution with serious non-NF soft tissue infection within three weeks of having primary varicella served as controls. After adjusting for age, sex, and the presence of group A strep, children who developed NF were approximately 10 times more likely to have used ibuprofen than controls. Eighty-four percent of NF cases were due to group A strep, compared with 27 percent of soft tissue infections among controls. In most cases, ibuprofen was begun after the onset of secondary infection. Cases were more likely than controls to have had bacteremia, streptococcal toxic shock syndrome, hypotension, or coagulopathy. No association was found between NF and acetaminophen use.

Comment: Although NF and ibuprofen use were associated, a causal relation was not proved. However, the authors suggest that the potential of NSAID use to inhibit immunologic response, or to mask symptoms and thus delay treatment, might be responsible. Clinicians should at least be alert to the possibility of increased risk for NF when ibuprofen is administered during varicella infection.

— RA Dershewitz

Published in Journal Watch General Medicine April 20, 1999

Citation(s):

Zerr DM et al. A case-control study of necrotizing fasciitis during primary varicella. Pediatrics 1999 Apr 103 783-790.

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