Rapidly Progressive Necrotizing Soft Tissue Infection of the Chest Wall After Skeletal Muscle Injury in a Healthy...

Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies characterized by rapid tissue destruction, systemic toxicity, and high mortality. Early recognition and aggressive treatment are critical.

A previously healthy 28-year-old male presented with one week of right shoulder and chest wall pain. Initially diagnosed with muscle strains via MRI, he re-presented to the emergency department five days later with hypotension. Blood cultures grew Streptococcus pyogenes, and imaging revealed extensive soft tissue involvement. Emergent fasciotomy and serial debridement revealed NSTI extending from the right shoulder to the scrotum and contralateral shoulder. Despite broad-spectrum antibiotics, debridements, continuous renal replacement therapy, and vasopressors, the patient developed multi-organ failure and died within 24 h of ICU admission.

This case highlights the aggressive nature of NSTIs, the importance of early diagnosis, a non-classical presentation, and the potential for rapid progression to multi-organ failure and death even in young, previously healthy individuals.