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A toddler complained of leg pain. His parents thought he hurt it. It was necrotizing fasciitis

Bryson Crenshaw, 4, said his knee hurt. His parents thought he injured it playing. They learned he had a shocking diagnosis of flesh-eating bacteria.
/ Source: TODAY

In December, the Crenshaw family came down with the flu. When then 3-year-old Bryson started feeling ill, mom Megan Crenshaw thought he had a bug and gave him some Tylenol. Then Bryson complained of muscle soreness.

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

“He was just saying, ‘Mommy, my leg hurts a little bit.’ And I would rub it,’” Megan Crenshaw, 35, of Lafayette, Indiana, tells TODAY.com. “That evening, my husband and I decided to take him into the hospital, and he wanted me to carry him.” The Crenshaws soon learned 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, never knew anybody who had it,” Megan Crenshaw says. “Leave it up to our kid to have the rarest disease that I have ever heard of, and now we’re going on this journey.”

Lethargy and leg pain

When Bryson complained of the leg pain that didn’t seem to get better, his parents took him to the emergency room. His symptoms quickly 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,” Megan Crenshaw recalls. “I was like, 'He has been complaining a little bit about his leg being sore, but I didn’t see anything. He hasn’t fallen recently or anything.’”

The Crenshaws mentioned that their family had recently had the flu, and they thought that Bryson also had it. But the doctor noticed Bryson’s knee was swollen and performed an X-ray. His parents thought perhaps he injured his knee from jumping off the couch or skipping a few steps as he ran down them. The doctor knew immediately what Bryson had.

“He showed me where there was like a blackish, almost like a darkness in the X-ray, and he said ... ‘It’s necrotizing fasciitis,’” Megan Crenshaw says. “He said, ‘It’s a very fast progressing infection of the soft tissue. It can be fatal.’”

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

The Crenshaws felt stunned by the news.

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

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

“I’m a helicopter mom,” Megan Crenshaw says. “All the answers were ‘no,’ so we were just a little dumbfounded.”

As soon as he arrived at Riley, doctors whisked him back for another scan to understand where the infection was. He was soon in surgery for to clean the infected tissue out of his leg. A second scan revealed the infection had progressed.

“The infection looks like it was traveling toward his hip and up his abdomen … and he had some (dead) tissue in his small intestines, his colon, and they also had to remove his appendix," Megan Crenshaw explains.

Bryson Crenshaw, Megan Crenshaw, Ben Crenshaw, Riley, bell-ringing, inpatient rehab
After being in the hospital most of January and February for surgeries and rehabilitation, Bryson Crenshaw was able to ring a bell to celebrate his early release home.Courtesy Mike Dickbernd/Riley Children’s Health

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

“There is nothing you can do. As a parent, you just want to protect your children,” dad Ben Crenshaw tells TODAY.com. “It was like you just hit the reset button on your life.”

Treating necrotizing fasciitis

Necrotizing fasciitis is rare. In the United States, about 700 to 1,500 people annually will be infected by necrotizing fasciitis, according to the Centers for Disease Control and Prevention.

“Necrotizing fasciitis is a very uncommon condition, especially in a child this age,” Dr. Christine Caltoum, medical director of surgical operations and division chief pediatric orthopedic surgery at Riley Children’s Health, who was involved in Bryson’s care, tells TODAY.com. “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 we typically see in those cases.”

While a variety of bacteria can cause it, experts believe that Group A streptococcus is the most likely culprit behind necrotizing fasciitis, the CDC says. 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 severe illness — including necrotizing fasciitis, pneumonia and streptococcal toxic shock syndrome.

In December 2022, around the same time that Bryson developed his infection, the CDC warned of an increase in cases of invasive Group A strep in young kids. Two U.S. 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 last fall's surge in respiratory viruses in kids.

"Whenever we see a huge amount of respiratory viruses, we know we are going to see a bump up in bacterial infections,” Dr. Michael Green, medical director of infection prevention and antimicrobial stewardship at the UPMC Children’s Hospital of Pittsburgh, previously told TODAY.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 recall Bryson having any cuts or scrapes.

“He had a very rapidly progressing case of necrotizing fasciitis,” Caltoum says. “We do see, in general, bone and joint infections in kids, and the majority of times they just contract these without us knowing why they happen. Sometimes there can be some pre-existing trauma, but in the vast majority of cases there isn’t.”

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 it’s hard to know necessarily where something started or where it ended,” Dr. Stefan Malin, a critical care physician at Riley Children’s Health, who was involved in Bryson’s care, tells TODAY.com.

Bryson Crenshaw, Megan Crenshaw, Ben Crenshaw, Riley, bell-ringing, inpatient rehab
Megan Crenshaw feels so proud of her son for being as upbeat, independent and spirited as he was prior to contracting necrotizing fasciitis. Courtesy Mike Dickbernd/Riley Children’s Health

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

“The necrotizing fasciitis had progressed so rapidly,” Caltoum says. “There was a lot of non-viable tissue within the leg. So, a lot of dead muscle, a lot of dead areas that were just not going to be salvageable.”

Doctors performed a nontraditional amputation, where one of Caltoum’s partners removed the dead tissue and bone and used the healthy tissue and bone to reconstruct his leg. The amputation is considered above the knee, but using some of the healthy tissue and bone from the lower limb made it more stable.

“It gives Bryson a longer limb, if you will, so he’s going to have an easier time with the prosthesis in the long term,” Caltoum explains. “We know kids do very well. They’re resilient. They learn to do all kinds of things — run, jump, play do sports with a prosthesis. So, we are very hopeful for him.” 

Bryson Crenshaw, Megan Crenshaw, Ben Crenshaw, Riley, bell-ringing, inpatient rehab
The Crenshaw family can tell that Bryson's feeling more like himself after his scary experience with necrotizing fasciitis: He's annoying everyone, picking fights with his brother, DJ, and generally having a good time at home.Courtesy Mike Dickbernd/Riley Children’s Health

Rehabilitation and home

On Jan. 18, Bryson underwent amputation surgery. Prior to the procedure, a wise toddler comforted his dad.

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

The Crenshaws felt impressed that Bryson's medical team was able to use his healthy muscle and bone from his lower leg to rebuild his thigh. After that, Bryson underwent a skin graft from his left leg to his right thing to assist healing. Later, they did a needle aspiration to remove some built up fluid. Every few days, he underwent blood tests to make sure the infection wasn’t still spreading.

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

Gradually he improved.

“Eating was better. Fevers were more controlled,” she says.

Eventually, Bryson went to in-patient rehabilitation and did so well that he came home two weeks earlier than expected. Until he has his prosthetic leg, he is using a wheelchair and walker. His parents have even found him scooting on his behind to get around if needed. The now 4-year-old is “very independent” and not afraid to tell others what happened to him, his mom says.

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

Riley, Bryson Crenshaw, Megan Crenshaw, Kristen Bartheld, Emily Lazarek, Dr. Francisco Angulo-Parker, physical therapy, Necrotizing facciitis
Bryson Crenshaw, 4, did so well in rehabilitation that he left two weeks early. He's cruising around the house in a wheelchair or a walker to enjoy the things he did before falling ill.Courtesy Mike Dickbernd/Riley Children’s Health

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

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