Erythromycin extravasation mimicking necrotising fasciitis in the infant

Erythromycin is a broad-spectrum antimicrobial drug that belongs to the macrolide family. Extravasation injuries with erythromycin can mimic necrotising fasciitis and are associated with extensive tissue loss. We present a case of erythromycin extravasation in a 1-year-old child with significant comorbidities. The presentation of blistering and deep dermal necrosis followed extravasation of an unknown volume of erythromycin and required urgent plastic surgery review and tissue reconstruction. This represents the first reported case of erythromycin extravasation and graphically illustrates the potentially devastating effects of this uncommon injury. Little is known about the mechanism of injury in erythromycin extravasation, though it is likely to be multifactorial. Immediate management is with local irrigation of the injury site, elevation and symptomatic relief. In large-volume extravasations and late diagnosis, the clinical signs are much more pronounced, with rapid necrosis and tissue loss which can mimic necrotising fasciitis.