Necrotizing Myositis
last authored: Sept 2009, David LaPierre
last reviewedL
Introduction
Necrotizing soft tissue infection.
High mortality, ~30%
Often caused by Claustridium
90-200 cases annualy in Canada
The Case of...
Causes and Risk Factors
80% are polymicrobioal
post op, beeing
Type II monomycrobial
- staph, strep, enterobacter, bacteroides
risk factors
- age
- HIV
Pathophysiology
Pathogens proliferate withing sc tissue producing enzymes and toxins.
Signs and Symptoms
- history
- physical exam
History
Pain in response to movement, is the usual presenting complaint
skin changes
Physical Exam
tense edema and ecchymosis
crepitus
painless balck necrotic ulcers
signs of distributive shock (fever, hypotension, tachycardia)
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
CK can show muscle breakdown
Diagnostic Imaging
CT can show fluid stranding
Differential Diagnosis
Treatments
Aggressive fluid resuscitation
IV broad spectrum antibiotics
OR for aggressive debridement
Question of role for hyperbaric oxygen or IVIG.
Consequences and Course
Resources and References
Topic Development
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