Related Experiment Videos
Streptococcal myositis and tissue necrosis with intramuscular administration of diclofenac (Voltaren)
1Department of Anaesthesia, Regional and University Hospital, Trondheim, Norway.
Abstract:
The authors describe a fatal case of a group A beta-haemolytic streptococci infection. The symptoms seemed to have been initiated by minor skin trauma; intramuscular injections of diclofenac (Voltaren) and metoclopramide (Primperan) after which the patient developed extensive muscle necrosis. The clinical course was rapid and he died within 48 hours after the first injection from circulatory collapse, probably due to overwhelming septicaemia with group A beta-haemolytic streptococci. Streptococcal myositis is a rare and extremely serious complication of skin trauma. Muscle necrosis is also a known but rare side effect of intramuscular administration of drugs (the "Nicolau syndrome") in which non-steroid anti-inflammatory drugs are often implicated. The case is discussed in the context of this specific syndrome.
Insights
A rare case of severe group A beta-haemolytic streptococci infection led to rapid muscle necrosis and death. This highlights the risks of intramuscular injections, particularly non-steroid anti-inflammatory drugs, in cases of skin trauma.
Area of Science:
- Infectious Diseases
- Toxicology
- Pathology
Background:
- Group A beta-haemolytic streptococci (GABHS) infections can lead to severe complications.
- Intramuscular drug administration carries potential risks, including localized tissue damage.
- The Nicolau syndrome is a rare adverse reaction associated with drug injections, often involving non-steroid anti-inflammatory drugs (NSAIDs).
Observation:
- A patient developed extensive muscle necrosis following intramuscular injections of diclofenac (Voltaren) and metoclopramide (Primperan) after minor skin trauma.
- The patient's condition rapidly deteriorated, leading to circulatory collapse within 48 hours.
- Overwhelming septicaemia caused by GABHS was the probable cause of death.
Findings:
- This case illustrates a potential link between intramuscular injections and the rapid progression of streptococcal myositis.
- Muscle necrosis, a known but rare side effect of intramuscular drugs (Nicolau syndrome), was observed.
- GABHS infection was identified as the primary driver of the fatal outcome.
Implications:
- Healthcare providers should be aware of the potential for severe GABHS infections following minor trauma, especially when combined with intramuscular injections.
- The risk of Nicolau syndrome, particularly with NSAIDs, warrants careful consideration in clinical practice.
- Prompt diagnosis and management of suspected streptococcal myositis are critical due to its high mortality rate.