Management of necrotizing myositis in a field hospital: a case report.
Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes: i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power- in a swollen limb with/without preceding trauma. ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining- of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation- to indicate myonecrosis. iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin. iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration- its hallmark. v. Emergent radical debridement. vi. Primary closure with viable flaps - unconventional, if need be.
Department of Surgery, 60 Parachute Field Hospital, C/O 56 APO, 904060, India. sarangabharathi@rediffmail.com
Ramanathan Saranga
RS
Bharathi
Vinay
V
Sharma
Rohit
R
Sood
Arunava
A
Chakladar
Pragnya
P
Singh
Deep Kumar
DK
Raman
D000369:Aged, 80 and over; D003646:Debridement; D006801:Humans; D007866:Leg / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000503:physiopathology / Q000601:surgery*; D009336:Necrosis / Q000601:surgery; D017192:Skin Diseases, Bacterial; D013290:Streptococcal Infections / Q000473:pathology / Q000601:surgery; D013297:Streptococcus pyogenes / Q000472:pathogenicity