Necrotizing Myositis in a Neutropenic Patient: The Use of Ultrasound in the Diagnosis of Atypical Presentations

Abstract

We report a case of fatal necrotizing soft tissue infection (NSTI) due to Clostridium perfringens (CP) in a neutropenic patient with diabetes mellitus. As in many cases, by the time a diagnosis was made, the condition had rapidly progressed to its late stages, resulting in a fatal outcome. The emergency physician should be aware of NSTI as a complication when patients present with pain out of proportion to physical findings and/or signs of soft tissue compromise. Negative prognostic factors for survival are diabetes mellitus, immunosuppression, age, and toxic shock syndrome. A bedside ultrasound scan allows for rapid evaluation in time-sensitive critically ill patients and can promote prompt treatment without the need to delay for further imaging studies.

Ultrasound for the diagnosis of infectious diseases: Approach to the patient at point of care and at secondary level

“…A disorganization of the muscular fibers indicates myonecrosis, whereas gangrenous fasciitis preserves the muscle. 21 (See Fig. 4) Ultrasound of pyomyositis reveals diffuse muscle swelling with edema (muscle hyperechogenicity with or without localized hypoechogenicity) and diffuse hyperaemia.…”