Necrotizing Myositis: A Rare Necrotizing Soft Tissue Infection Involving Muscle

• Published in: Wounds (King of Prussia, Pa.) Vol. 30; no. 12; pp. E116 - E120
• Main Authors: Boinpally, Harika, Howell, Raelina S, Ram, Bebu, Donovan, Virginia, Castellano, Michael, Woods, John S, Gorenstein, Scott
• Format: Journal Article
• Language: English
• Published: United States 01.12.2018
• Subjects: Aged; Clostridium Infections; Fasciitis, Necrotizing - diagnostic imaging; Fasciitis, Necrotizing - etiology; Fasciitis, Necrotizing - pathology; Fasciitis, Necrotizing - therapy; Humans; Hyperbaric Oxygenation; Male; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - pathology; Myositis - diagnostic imaging; Myositis - pathology; Myositis - therapy; Negative-Pressure Wound Therapy; Prostatic Neoplasms - radiotherapy; Pubic Symphysis - diagnostic imaging; Pubic Symphysis - pathology; Radiation Injuries - diagnostic imaging; Radiation Injuries - pathology; Soft Tissue Infections - diagnostic imaging; Soft Tissue Infections - pathology; Soft Tissue Infections - therapy; Streptococcal Infections; Thigh - diagnostic imaging; Thigh - pathology; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1943-2704

Necrotizing myositis (NM) is an extremely rare necrotizing soft tissue infection involving muscle. Unlike similar infections (eg, necrotizing fasciitis, clostridial myonecrosis) that can be more readily diagnosed, NM can have a benign presentation then rapidly progress into a life-threatening condition with a mortality rate of 100% without surgical intervention. A 74-year-old man with a history of prostate cancer with radiation therapy, seed implants, and 2 transurethral resection procedures presented to the emergency department after a fall. He was initially diagnosed and treated for urosepsis. Sixteen hours after presentation, he complained of pain and swelling of his right groin. Computed tomography of the abdomen and pelvis showed gas findings suspicious for necrotizing infection of the bilateral thighs. Surgical exploration revealed NM. Separate cultures from the left thigh and bladder grew Streptococcus intermedius, Clostridium clostridioforme, and Peptostreptococcus, suggesting a possible common source of infection from the prostate gland or the osteomyelitic pubic symphysis, which subsequently spread to the bilateral thighs. To the best of the authors' knowledge, this is the first reported case of S intermedius and C clostridioforme causing NM. A high index of suspicion is required for extremely rare conditions like NM, because early diagnosis and surgical intervention significantly reduce mortality.