Necrotising myositis - learnings for a plastic surgeon

Area of Science:

• Medical Research
• Infectious Diseases
• Surgical Training

Background:

• Necrotising myositis (NM) is a critical medical emergency with high morbidity and mortality.
• Early diagnosis of NM is challenging due to non-specific initial symptoms, often delaying prompt treatment.
• The absence of early cutaneous signs contributes to delayed recognition and poorer patient outcomes.

Purpose of the Study:

• To analyze demographics, epidemiology, etiology, clinical features, diagnosis, and treatment of necrotising myositis.
• To enhance the diagnostic capabilities of plastic surgeons in training for necrotising myositis.
• To provide insights into the clinical course and outcomes of necrotising myositis.

Main Methods:

• Systematic review of publications on necrotising myositis from 1974 to January 2020.
• Data extracted from Embase, Medline All, Web of Science, Google Scholar, and Cochrane.
• Exclusion of animal studies, statin-induced myotoxicity, and autoimmune myositis; quality assessment using JBI Critical Appraisal Checklist.

Main Results:

• Most common initial presentation: flu-like symptoms and myalgia.
• Mean age of patients: 43.3 years; 82% had no significant prior medical history.
• Frequent misdiagnoses: muscle strain (11%), DVT (10%), viral illness (9%).
• Group A Streptococcus was the cause in 74% of cases; 3.5% were polymicrobial.
• High mortality rate of 36.5%, often due to rapid sepsis and multi-organ failure.

Conclusions:

• Necrotising myositis is a life-threatening bacterial infection presenting a diagnostic challenge.
• Initial symptoms like myalgia without trauma mimic less severe conditions, complicating diagnosis.
• A high index of suspicion and increased clinical awareness are vital to reduce necrotising myositis morbidity and mortality.