Tackling Necrotizing Fasciitis
How CHRISTUS Children’s Helped Alé Get Back to Football
Alé Ramirez loves playing football and there’s not much that can keep him off the field. Even on his 16th birthday, September 13, 2024, Alé couldn’t wait to put on his uniform.
The following day, when Alé complained about a “very sore throat,” his mother, Mandy, took him to the doctor. He tested negative for everything except mononucleosis, commonly known as mono, and was advised to stay off the field – and stay in bed – for a week.
That day marked the beginning of a nightmare for the Ramirez family. In the following days, Alé’s condition deteriorated rapidly, his mother recalled. He struggled to eat because swallowing became impossible, his pain intensified, and dehydration set in as even drinking water was too painful. Soon, he became severely congested, making it hard for him to breathe.
Later that week, Mandy decided enough was enough. Between the painful sore throat, constant coughing, and a nosebleed that wouldn’t subside, she thought it was time to get Alé to the Pediatric Emergency Room at CHRISTUS Children’s. Soon after, he was admitted with a fever of 104 degrees.
“He had sharp pains in his throat and we just thought it was a very bad case of mono,” Mandy said. “When he was admitted, I thought to myself, ‘OK, he’ll get antibiotics, and it will be a quick hospital stay. He was where he needed to be.’”
The following day, Alé’s spleen was inflamed, everything was hurting and the high dose of painkiller – morphine – wasn’t helping. He was transferred to the Pediatric Intensive Care Unit (PICU).
CHRISTUS Children's
CHRISTUS Children's
CHRISTUS Children's in San Antonio provides expert pediatric care through a network of clinics, emergency centers, and specialty services, supporting children, expectant moms, and families with compassionate, comprehensive medical care.
Dr. Arjun Chandran, a pediatric critical care specialist, was the attending physician on call in the PICU that night. He used a suction device to clear saliva from Alé’s airway because he wasn’t able to swallow at all.
He endured one more night of the pain, fever and extreme lethargy before it was clear Alé needed more invasive intervention. “He motioned to me that he couldn’t breathe and started gasping for air,” Mandy said.
Alé’s father, Bryan, ran to get the nurse. “Immediately there was a team of nurses and doctors, responding to the code,” Mandy added. “They put him on oxygen and gave him medicine to open his airway. I watched my son turn from gray to blue. It was so frightening.”
Controlling Alé’s Airway
Dr. Chandran responded immediately, saying it was time to take steps to prevent Alé’s airway from closing again. “He told us he needed time to figure out what was going on and the next step was to intubate Alé so his airway could be controlled,” Mandy said. Intubation is a medical procedure that involves inserting a tube into a patient's airway to keep it open, ensuring the patient can breathe properly when he or she is unable to do so on their own.
“Dr. Chandran saved Alé’s life. If it weren’t for him, Alé would have coded again and I’m not sure they would have been able to resuscitate him. I don’t think Alé would be here,” Mandy said,
adding that she was immediately impressed with Dr. Chandran and the entire nursing staff. “They promised to do everything possible to control Alé’s pain.”
Mandy and Bryan joined the doctors, Dr. Chandran and Dr. Mark Boston, chief of Pediatric Otolaryngology at CHRISTUS Children’s, in explaining the procedure to Alé and his sister, Bella, 17. Dr. Boston explained intubation meant placing Alé into an induced coma to keep him still while a ventilator took over his breathing. An induced coma is a temporary, medically induced state of unconsciousness that slows brain activity and prevents movement, allowing the body to rest and heal.
“I wanted to make sure Alé understood everything that was happening,” Mandy said. “We decided it was time to intubate when Alé said, ‘I don’t care what you do. Just make the pain go away. Do anything you need to do to stop this pain.’”
The entire family gathered around his bed and kissed him before the team came to take him for what would become the first of seven surgeries Alé underwent at CHRISTUS Children’s.
“After that procedure, Dr. Boston and Dr. Chandran told us that Alé’s airway was so inflamed that they were barely able to put in a breathing tube. That’s when I knew the decision we made to intubate was the right one,” Mandy said.
A Tracheotomy is Inserted
Mandy, Bryan, and Bella saw Alé right after surgery. “He had seven IVs and there were so many machines,” Mandy said. “I’ve never been so scared. But the doctors and nurses were amazing and that helped a lot. They explained every procedure and answered every question we had.”
At last, Alé was resting comfortably in an induced coma, and a family member always sat vigil by his side. Mandy and Bryan decided to go home to get some fresh clothing when they received a call from Mandy’s mother, who was with Alé. “She said, ‘get back to the hospital right now. The doctors said they need to take him to the operating room now!’”
The family rushed back to the hospital, where Alé’s second trip to the OR finally revealed the cause of his throat pain and inability to swallow. He required a tracheotomy, a necessary procedure to allow constant suctioning of the thick phlegm blocking his airway. A tracheotomy is a surgical procedure that creates an opening in the neck to provide a direct airway to the lungs.
A Frightening Diagnosis: Necrotizing Fasciitis
After a roller coaster of a week, Alé’s family finally received a diagnosis. “The doctors were able to look inside the throat beyond the inflammation and they found out he had necrotizing fasciitis,” Mandy said. “They took samples to find out what type of bacteria it was and we waited a few days before he was put on the correct medication.”
Necrotizing fasciitis, commonly known as "flesh-eating disease," is a severe bacterial infection that affects the tissue beneath the skin, known as the fascia.
Alé was closely monitored to ensure the infection in his throat didn't spread to his lungs or brain. Fortunately, it didn't. However, Mandy said they still don't know where the infection originated. "The doctors told us this type of infection had never been seen in a healthy 16-year-old. It's typically found in long-time smokers."
Thankfully the medication he received saved Alé’s life. And even though they don’t understand the “how” and the “why” of Alé’s ordeal, his family has nothing but gratitude for Alé’s medical team. “We cannot begin to express how thankful we are for Alé’s team of medical professionals at CHRISTUS Children’s,” Mandy said. “Every person – from respiratory therapists to all the doctors to the infectious disease specialists to every single nurse we encountered – was absolutely amazing. They were so great with communication,” Mandy said. “They explained every single thing they were doing to get the infection under control.”
Less than a month later on October 9, 2024, when the doctors brought Alé out of the medically induced coma, Alé coughed out his breathing tube and was breathing on his own. Over the following week, Alé insisted on walking and eventually began to toss a football in his ICU room with his father.
Finally, Alé was transferred to CHRISTUS Children’s pediatric inpatient rehabilitation unit where he learned how to swallow again, received speech therapy to strengthen his vocal cords and underwent physical rehabilitation to get stronger.
“Alé just wanted to get back to his life,” Mandy said. “He was very determined to do everything they told him in rehab.”
Infectious Disease Gives Alé a New Outlook on Life
Alé was cleared to return to school in early January 2025.
“I’m hanging out with my girlfriend and my friends, and I am hoping to play spring football. I’ll definitely be playing in the fall,” Alé said. “I’m also going to be running track and field.”
He also has a new outlook on his life. “I don’t want to be spending any time doing things I don’t need or want to do. I value life more now. I know there are many ways to waste time and I’m not going to be doing that. I want to stay busy and be productive.”
The high school junior is hoping to play football in college and he is thinking about a sports-related career – maybe as a sports manager or agent.
Wherever he goes and whatever he does, he will always be thankful to the doctors and nurses at CHRISTUS Children’s. “They were amazing,” Alé said. “There wasn't a day that they didn’t check up on me every few hours. I really felt like I was in the right place getting the best care.”
Learn more about the Pediatric Infectious Disease Clinic, the Pediatric Ear, Nose, & Throat (ENT) Clinic, or the Pediatric Inpatient Rehabilitation Unit at CHRISTUS Children's in San Antonio.
