Group A streptococcal necrotising fasciitis in the right interpectoral plane: a case series of paediatric patients

Necrotising fasciitis (NF) is a life-threatening skin and soft tissue infection, often caused by Streptococcus pyogenes (Group A Streptococcus). We describe three paediatric patients with NF within the right interpectoral plane. Despite severe systemic illness, classic cutaneous signs were absent in two cases. Imaging and intraoperative findings were consistent with extensive fascial necrosis and deep tissue infection, without a clear cutaneous portal of entry. Group A Streptococcus, including M1UK strains, was identified in all cases, with clinical and radiological findings suggesting lymphatic spread from the oropharynx as a possible mechanism of infection migration. This case series highlights the importance of early recognition and prompt, aggressive management of NF, while also illustrating how awareness of skin perfusion can complement surgical planning.