title: Streptococcal necrotizing myositis: a case report and clinical review.
abstract: BACKGROUND
  Streptococcal necrotizing myositis, also known as gangrenous myositis, is a very rare and severe soft tissue infection that predominately involves skeletal muscle and, eventually, superficial fascia and surrounding tissues. The presentation is often nonspecific until the rapidly progressing clinical course becomes apparent. A high morbidity and mortality rate has been reported in the small number of cases since 1900. Despite several attempts to better define the different entities causing necrotizing myositis, no single definitive causal relationship has been defined.
  
  
  OBJECTIVE
  A review of the literature is presented here to help clinicians distinguish those with necrotizing myositis from those with nonnecrotizing myositis when the clinician is at all confronted with the suspicion for such an infection.
  
  
  METHODS
  The case presented is that of a 48-year-old woman who had streptococcal necrotizing myositis. She died roughly 72 h after admission. After the patient's death, the clinical team sought consent for autopsy. Hospital staff made contact with family, and information was obtained from the family that the onset of the patient's symptoms was allegedly temporally related to her acquisition of a new tattoo on the right back, where the tattoo process allegedly included injection of cremated ashes of a pet dog.
  
  
  CONCLUSIONS
  A high level of suspicion for necrotizing myositis must be maintained for a patient with unexplained severe muscle pain and soft tissue swelling accompanied by systemic inflammatory response syndrome.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Hourmozdi
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Hawley
authors.affiliation: Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Christiane M
authors.initials: CM
authors.lastname: Hadi
authors.affiliation: Department of Radiology and Imaging Science, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Bilal
authors.initials: B
authors.lastname: Tahir
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Rawle A
authors.initials: RA
authors.lastname: Seupaul
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006119:Groin; D006615:Hip; D006801:Humans; D008875:Middle Aged; D009220:Myositis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D009336:Necrosis; D010146:Pain / Q000382:microbiology; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D013653:Tattooing / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents
keywords: myositis; necrotizing; review; streptococcal infections; streptococcal necrotizing myositis; streptococcal toxic shock syndrome