Toddler leg pain would not improve. It was flesh-eating bacteria

In December, the Crenshaw family caught the flu. When Bryson, then 3, started feeling sick, his mother Megan Crenshaw thought he had a bug and gave him Tylenol. Then Bryson complained of muscle aches.

The Crenshaw family had never heard of necrotizing fasciitis until Bryson complained of a sore leg and tests revealed he had a flesh-eating bacterial infection.Courtesy of the Crenshaw family

“He was just like, ‘Mom, my leg hurts a little.’ And I would scrub it,” Megan Crenshaw, 35, of Lafayette, Indiana, told “That night, my husband and I decided to take him to the hospital, and he wanted me to wears it.” The Crenshaws soon realized what was wrong: Bryon had necrotizing fasciitis, also known as flesh-eating bacteria.

“We didn’t know what necrotizing fasciitis was. We had never heard of it, we never knew anyone who had it,” says Megan Crenshaw. “Leave our child to have the rarest disease I’ve ever heard of, and now we’re off on this journey.”

Lethargy and leg pain

When Bryson complained of leg pain that didn’t seem to be improving, his parents took him to the emergency room. His symptoms rapidly worsened.

“The doctor came in and noticed he wasn’t putting any weight on his leg. So the doctor asked him, ‘Does your leg hurt?’ And he said, ‘My knee hurts.’ And he was rubbing his leg, ”recalls Megan Crenshaw. “I was like, ‘He complained a bit about his leg hurting, but I didn’t see anything. He hasn’t fallen down recently or anything.

The Crenshaws mentioned that their family had recently had the flu and they thought Bryson had it too. But the doctor noticed Bryson’s knee was swollen and performed an X-ray. His parents thought he may have hurt his knee jumping off the couch or skipping a few steps while running down them. The doctor immediately knew what Bryson had.

“He showed me where there was like a blackish, almost like darkness in the x-ray, and he said… ‘It’s necrotizing fasciitis,'” Megan Crenshaw says. is a soft tissue infection that progresses very quickly and can be fatal.

The family surprised older brother DJ with Bryson’s early release from inpatient rehab. DJ knew his brother was feeling better when the 4-year-old started wielding his Nerf gun.Courtesy of the Crenshaw family

The Crenshaws were stunned by the news.

“It was like, ‘What is this? How did he figure it out? Do we need to move? This is our home? Should we be worried about our other child? We need more information. Is it contagious?” said Megan Crenshaw. “(There) were so many thoughts going through our minds.”

Bryson was to be transferred to Riley Hospital for Children in Indianapolis. Doctors flooded the family with questions: Did their dog bite or scratch Bryson? Did he swim in a stream or in contaminated water? Had he done anything out of the norm recently?

“I’m a helicopter mom,” says Megan Crenshaw. “All the answers were ‘no,’ so we were kind of stunned.”

As soon as he got to Riley, doctors brought him back for another scan to figure out where the infection was. He was soon operated on to clean the infected tissue from his leg. A second analysis revealed that the infection had progressed.

“The infection seems to be spreading to his hip and abdomen…and he had (dead) tissue in his small intestine, his colon, and they had to remove his appendix as well,” Crenshaw said.

After being in hospital for most of January and February for surgery and rehabilitation, Bryson Crenshaw was able to ring a bell to celebrate his early release.Courtesy of Mike Dickbernd/Riley Children’s Health

Bryson underwent his second surgery within 24 hours for doctors to remove dead tissue from his abdomen and appendix.

“There is nothing you can do. As a parent, you just want to protect your kids,” dad Ben Crenshaw told “It felt like you just pressed the reset button on your life.”

Treating Necrotizing Fasciitis

Necrotizing fasciitis is rare. In the United States, about 700 to 1,500 people a year will become infected with necrotizing fasciitis, according to the Centers for Disease Control and Prevention.

“Necrotizing fasciitis is a very rare condition, especially in a child of this age,” Dr. Christine Caltoum, Medical Director of Surgical Operations and Division Chief of Pediatric Orthopedic Surgery at Riley Children’s Health, told who was involved in Bryson’s care. “We tend to see a case of necrotizing fasciitis maybe every one to two years, and the severity of his disease is much higher than what we typically see in these cases.”

Although various bacteria can cause it, experts believe that group A strep is the most likely culprit of necrotizing fasciitis, according to the CDC. A group A strep infection usually causes mild symptoms, such as strep throat or impetigo, a bacterial skin infection. But when the infection becomes invasive—meaning it spreads to the part of the body where it doesn’t usually go—it can cause serious illness, including necrotizing fasciitis, pneumonia, and dementia syndrome. streptococcal toxic shock.

In December 2022, around the same time Bryson developed his infection, the CDC warned of an increase in cases of invasive group A strep in young children. Two American children died of invasive strep A between October and December last year. The CDC recently reported that the reason for the increase in invasive strep A was likely the outbreak of respiratory viruses among children last fall.

“Any time we see a huge amount of respiratory viruses, we know we’re going to see an increase in bacterial infections,” said Dr. Michael Green, medical director of infection prevention and antimicrobial stewardship at the UPMC Children’s Hospital of Pittsburgh. .com.

The Crenshaws believe Bryson had the flu shortly before developing necrotizing fasciitis. People also develop flesh-eating bacteria when the bacteria enter through a wound, but Megan Crenshaw says she doesn’t remember Bryson having any cuts or scrapes.

“He had a case of necrotizing fasciitis that was progressing very quickly,” Caltoum says. “We see, in general, bone and joint infections in children, and most of the time they get them without us knowing why they occur. Sometimes there may be pre-existing trauma, but in the vast majority of cases there is none.

Doctors performed about 10 to 11 surgeries on Bryson, including surgery on his abdomen, to try to stop the infection.

“The difficult part with a lot of these cases and Bryson’s case is that it’s hard to necessarily know where something started or where it ended,” said Dr. Stefan Malin, a critical care physician at Riley. Children’s Health, which was involved in Bryson’s care.

Megan Crenshaw is so proud of her son for being as optimistic, independent and feisty as he was before he contracted necrotizing fasciitis. Courtesy of Mike Dickbernd/Riley Children’s Health

Ultimately, doctors realized they couldn’t save Bryson’s entire leg.

“The necrotizing fasciitis had progressed so quickly,” says Caltoum. “There was a lot of non-viable tissue in the leg. So a lot of dead muscle, a lot of dead spots that just weren’t going to be salvageable.

Doctors performed an untraditional amputation, in which one of Caltoum’s partners removed dead tissue and bone and used healthy tissue and bone to reconstruct his leg. Amputation is considered above the knee, but using some healthy tissue and bone from the lower limb has made it more stable.

“It gives Bryson a longer limb, if you will, so he’ll have an easier time with the prosthesis in the long run,” says Caltoum. “We know that children do very well. They are resistant. They learn to do all sorts of things: run, jump, play sports with a prosthesis. So we have a lot of hope for him.

The Crenshaw family can say that Bryson feels more like himself after his frightening experience with necrotizing fasciitis: he annoys everyone, fights with his brother, DJ, and generally has a good time at home.Courtesy of Mike Dickbernd/Riley Children’s Health

Rehabilitation and home

On January 18, Bryson underwent surgical amputation. Before the procedure, a well-behaved toddler comforted his father.

“I was just sitting there holding his hand and crying,” Ben Crenshaw said. “He said, ‘Why are you crying.’ I said, ‘I’m just worried about you.’ He looked me straight in the eye and said, ‘Stop crying. It’s going to be OK.'”

The Crenshaws were impressed that Bryson’s medical team was able to use his healthy muscles and bones in his lower leg to reconstruct his thigh. After that, Bryson underwent a skin graft from his left leg to his right leg to help with healing. Later, they did needle aspiration to remove the accumulated fluid. Every few days he would have blood tests to make sure the infection wasn’t spreading yet.

“The hardest part for us after the amputation,” says Megan Crenshaw. “Why is he always sick?”

Gradually he improved.

“Eating was better. The fevers were better controlled,” she says.

Eventually, Bryson went to inpatient rehab and did so well that he went home two weeks earlier than planned. Until he has his prosthetic leg, he uses a wheelchair and a walker. His parents even found him trotting on his behind to get around when needed. The 4-year-old is “very independent” and not afraid to tell others what has happened to him, his mum says.

“We actually went to church yesterday, and a little kid walked up to him and asked, ‘What happened to your leg,'” Megan Crenshaw adds. “Bryson said to me, ‘Oh, I got an infection and (my leg) made me sick. So the doctor cut it.

Bryson Crenshaw, 4, did so well in rehabilitation that he left two weeks early. He walks around the house in a wheelchair or walker to enjoy the things he did before he got sick.Courtesy of Mike Dickbernd/Riley Children’s Health

The Crenshaws hope that when other parents hear their story, it will encourage them to advocate for their child’s health. Taking Bryson to the hospital when they did likely improved his outcome, doctors agree. The family is so impressed with their son.

” He is fine. I’m so proud of him. So proud of how far he’s come,” says Megan Crenshaw. “He’s a fighter and he’s determined.”

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