Infectious Diseases in Obstetrics and Gynecology 5:341-344 (1997) (C) 1998 Wiley-Liss, Inc. Maternal Death From Postpartum Necrotizing Fasciitis Arising in an Episiotomy: A Case Report Catherine M. Lynch, * Donna M. Pinelli, 1 C. Wayne Cruse,2 William N. Spellacy, 1 John T. Sinnott,3 and Ron G. Shashy 1 Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL eDepartmet of Surgery, Division of Aesthetic and Reconstructive Surgery, University of South Florida, Tampa, FL -Department of Medicine, Divisio of lfectious Diseases, Uiversity of South Florida, Tampa, FL ABSTRACT Background: Necrotizing fasciitis is a rare condition. We report a fatal case arising from an episi- otomy in a previously healthy woman. Case: A healthy 23-year-old prima gravida white female underwent vaginal delivery with repair of a proctoepisiotomy. Eighty-four hours postpartum, she developed increasing perineal swelling with severe pain. She presented on the 4th postpartum day with edema, erythema localized to the perineum, and vital signs significant only for tachycardia of 120/min. With a leukocytosis of 45,000/ pl (87%) neutrophils, she was admitted to the hospital with an initial diagnosis of perineal cellulitis and empirically started on broad-spectrum intravenous antibiotic therapy. The patient’s condition continued to deteriorate and she was then transferred to our facility on postpartum day 9 where a team performed two radical debridements of all necrotic tissue. Despite this and a broadened antibiotic coverage, the patient eventually experienced cardiopulmonary arrest and died on post- partum day 12. Conclusion: Necrotizing fasciitis must be considered in the differential diagnosis of the postpar- tum patient presenting with severe vulvar pain and erythema. Our patient exemplifies the obscure presentation with seemingly minimal skin changes. Any delay in diagnosis and treatment, which must include expeditious aggressive surgical debridement, will likely result in severe morbidity or mortality. Infect. Dis. Obstet. Gynecol. 5:341-344, 1997. (C) 1998 Wiley-Liss, Inc. KEY WORDS infection; surgical debridement; postpartum nccrotizing fasciitis; proctoepisiotom7 n the past 20 years there have been 8 case reports in the world literature regarding necrotizing fasci- itis in the postpartum period. 1,7,s We report a fatal case of necrotizing fasciitis arising in an episiotomy site in a previously healthy woman. CASE REPORT A healthy-23-year-old prima gravida white female with an uncomplicated prenatal course underwent a vacuum-assisted vaginal delivery with repair of a fourth degree episiotomy (proctoepisotomy). No antibiotics were administered for this tear. She was discharged with a healthy male infant 36 h later with no postpartum complications. Over the next 48 h the patient developed increasing perineal swelling. Severe pain and malaise ensued, making her unable to care for her infant. Due to her worsening condition, she presented to a local hospital on the 4th postpartum day. The involved area was edematous and erythematous and appeared to localize to the perineum. Vital signs were blood pressure 118/72 mmHg, respira- *Correspondence to: Dr. Catherine Lynch, Department of Obstetrics and Gynecology, University of South Florida, 4 Columbia Drive, Suite 529, Tampa, FL 33606. Case Report Received 23 June 1997 Accepted 3 November 1997