Management of necrotizing myositis in a field hospital: a case report

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine Vol. 17; no. 1; p. 20
• Main Authors: Bharathi, Ramanathan Saranga, Sharma, Vinay, Sood, Rohit, Chakladar, Arunava, Singh, Pragnya, Raman, Deep Kumar
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.04.2009; Springer Nature B.V; BioMed Central; BMC
• Subjects: Aged, 80 and over; Care and treatment; Case Report; Case reports; Case studies; Cellulitis; CT imaging; Debridement; Diagnosis; Histopathology; Humans; Inflammatory diseases; Ischemia; Laboratories; Leg - microbiology; Leg - pathology; Magnetic resonance imaging; Male; Medical protocols; Middle Aged; Musculoskeletal diseases; Myositis; Myositis - physiopathology; Myositis - surgery; Necrosis - surgery; Skin; Skin Diseases, Bacterial; Streptococcal Infections - pathology; Streptococcal Infections - surgery; Streptococcus pyogenes - pathogenicity; Trauma; Veins & arteries; X-rays
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/1757-7241-17-20

Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes: i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power- in a swollen limb with/without preceding trauma. ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining- of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation- to indicate myonecrosis. iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin. iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration- its hallmark. v. Emergent radical debridement. vi. Primary closure with viable flaps - unconventional, if need be.