Streptococcal Necrotizing Myositis: The Role of Magnetic Resonance Imaging
A Case Report
W. M. Tang, FRCS(Ed); J. W.K. Wong, FRCS(Ed); L. L.S. Wong, FRCR; J. C.Y. Leong, FRCS(Ed)

Streptococcal necrotizing myositis is a rare but severe infection of skeletal muscle that is caused almost exclusively by Streptococcus pyogenes (Group-A streptococcus). The literature on this condition is sparse. In 1930, Abrami and Worms1 reported on two patients who died of this infection. Since then, fewer than thirty cases have been reported, to our knowledge2-9. Streptococcal necrotizing myositis has a much more sinister prognosis than do other bacterial infections of skeletal muscle, such as pyomyositis. The condition is difficult to diagnose; hence, treatment is often delayed, contributing to its associated high mortality rate.

We report a case of a five-year-old girl who survived streptococcal necrotizing myositis. A high index of suspicion combined with emergent magnetic resonance imaging facilitated early diagnosis and radical débridement of the necrotic muscles. The clinical and magnetic resonance imaging features of streptococcal necrotizing myositis are compared with those of pyomyositis.

Case Report

A five-year-old nondiabetic girl presented with a twenty-four-hour history of severe pain in the left hip and thigh following a single day of fever that had resolved spontaneously one week prior to admission. There was no recent history of injury or injection in the region of the left buttock, hip, or thigh; chicken pox; or steroid intake.

The patient was attached to a cardiac monitor, and blood pressure was checked every fifteen minutes. Although she was febrile (39.5°C) and dehydrated, her vital signs were initially stable (pulse, 120 bpm; blood pressure, 100/50 mm Hg). The pain in the left lower limb prevented walking, and muscle spasm markedly limited the range of motion of the hip. The hip could be flexed passively to only 20°; other directions of movement were virtually impossible. Although no abnormalities of the overlying skin were evident, the left hip and thigh were diffusely swollen, with exquisite tenderness …

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