Necrotising myositis, the deadly impersonator

Area of Science:

• Infectious Diseases
• Surgical Pathology
• Critical Care Medicine

Background:

• Necrotising myositis is a rare but severe soft tissue infection.
• Patients may initially present with non-specific symptoms like limb pain and swelling, often with concurrent respiratory complaints.
• Delayed diagnosis can lead to rapid deterioration, multiorgan failure, and mortality.

Purpose of the Study:

• To report two cases of necrotising myositis caused by Group A Streptococcus (Streptococcus pyogenes).
• To emphasize the critical importance of early diagnosis and prompt intervention in managing this life-threatening condition.
• To highlight the subtle presentation of skin changes in patients with necrotising myositis.

Main Methods:

• Case report of two patients with necrotising myositis.
• Clinical presentation, investigations, and management strategies were detailed.
• Microbiological analysis identified Group A Streptococcus (Streptococcus pyogenes) as the causative agent.

Main Results:

• Both patients presented with limb pain, swelling, and respiratory symptoms, progressing to soft tissue necrosis and toxaemia.
• Surgical debridement and aggressive medical management were required.
• One patient underwent limb amputation, while the other succumbed to the infection despite intensive care.

Conclusions:

• Early recognition of necrotising myositis is vital, with pain being a primary symptom and skin changes often being late indicators.
• Prompt surgical debridement, antibiotic therapy, and intensive care support are essential for improving patient outcomes.
• The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score may aid in the early diagnosis of this aggressive infection.