Review of compartment syndrome due to group A streptococcal infection

To present a case of nontraumatic compartment syndrome secondary to group A streptococcal infection and review the literature regarding this unusual clinical entity.

Case reports of compartment syndrome due to group A streptococci in the English language literature were identified through a computer-generated search using MEDLINE 1950-2007. Reviews of the cited literature in pertinent articles were also undertaken to find additional cases. Cases with evidence of chronic infection or trauma were excluded; cases were included for analysis if enough demographic information was available to allow identification of individual patients.

Thirteen cases, including the current case of group A streptococcus, were identified. The average age was 34 years (range 2-76). The majority of patients (77%) were previously healthy with no significant medical history or evidence of immunosuppression. All patients presented with either fever, or hypotension, or white blood cells >10,000 cells/mm and 77% presented with at least 2 of these signs. All patients received prompt surgical intervention and antibiotic therapy with gram-positive activity. The mortality rate was 15%.

Nontraumatic acute compartment syndrome presenting with fever, or hypotension, or leukocytosis may be associated with infection such as group A streptococcus. Prompt surgical and antibiotic therapy was associated with a relatively low mortality rate. A high clinical index of suspicion should occur for the possibility of infection with an organism such as group A streptococcus in patients presenting with acute extremity pain and tense compartments without trauma and with signs of a systemic inflammatory response.