Scandinavian Journal of Infectious Diseases
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Streptococcal Myositis Lena Jahnson, Lars Berggren, Elisabet Björsell-ostling, Jan Bonnerstig & Hans Holmberg To cite this article: Lena Jahnson, Lars Berggren, Elisabet Björsell-ostling, Jan Bonnerstig & Hans Holmberg (1992) Streptococcal Myositis, Scandinavian Journal of Infectious Diseases, 24:5, 661-665, DOI: 10.3109/00365549209054654 To link to this article: http://dx.doi.org/10.3109/00365549209054654
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 7
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [RMIT University Library]
Date: 24 April 2016, At: 08:08
Scand J Infect Dis 24: 661-665, 1992 ~~
CASE REPORT
Streptococcal Myositis LENA JAHNSON', LARS BERGGREN', ELISABET BJORSELLOSlLING7. JAN BONNERSTIG4 and HANS HOLMBERG]
Downloaded by [RMIT University Library] at 08:08 24 April 2016
From the Departments of 'Infectious Diseases, 'Anaesthesia and Intensive Care, 'Regional Blood Cenrer and "OrthopredrcSurgery, Orebro Medical Center Hospital, Orebro. Sweden
Streptococcal myositis (SM), is a very serious condition with a high mortality rate. The port of entry of the infection is often unknown. We present here a case report concerning a 68-yearold patient with fulminant SM preceded by symptoms of an upper respiratory tract infection. Haemolytic streptococci of group A were found in the blood, muscle tissue and throat. The patient survived after massive therapeutic interventions including intensive care with intravenous antibiotics, fasciotomy, plasma exchange, controlled respirator ventilation and exarticulation through the shoulder. The patient's wife fell ill at the same time with a sore throat and the same type of streptococci (T-type 3) was found in both patients. L. Jahnson, M D , Department of Infectious Diseases, Orebro Medical Center Hospital, S-701 85 Orebro, Sweden
INTRODUCTION Streptococcal myositis (SM) is an unusual condition associated with a high mortality rate. Early diagnosis and treatment has, in certain cases, enabled its often fatal course to be halted. The cornerstones of therapy are considered to be aggressive surgery with immediate debridement. radical excision of necrotic tissue and appropriate antibiotic therapy. CASE REPORT A hX-year-old man who had enjoyed good health, fell abruptly ill on April 13 after just over a week of symptoms of a common cold. After a day of intensive physical labour (wood-chopping) he developed a temperature of 40°C and felt exhausted. The fever persisted and after 2 days pain suddenly developed in his right forearm. The pain increased and prevented him from sleeping. O n April 16 he went to his general practitioner and was sent from there to the emergency ward under the presumptive diagnosis of a muscle rupture. On admission at hospital the patient was in severe pain. The proximal portion of his forearm was markedly swollen. This swelling was less pronounced more distally. The forearm was slightly warm, almost board-like but without erythema. The radial pulse could be palpated normally whereas the ulnar pulsc was feeble. Initially movement of the wrist and fingers was good. In order to rule out bleeding or thrombosis an ultrasound examination was carried out. This demonstrated slightly swollen muscles of the forearm surrounded by fluid. but the findings were otherwise normal. O n renewed clinical examination approximately 5 h after admission, a faint, patchy erythema was noted on the volar forearm. Palpation of the forearm was nainful. The ulnar pulse could no longer be palpated and the radial pulse was weak. Flexion and abduction of the fingers and radial deviation of the wrist elicited severe pain. Superficial sensation on the ulnar aspect of the little finger was moderately diminished. O n attempting to make a fist there was a gap of 3 cm; a diminished capacity to flex the elbow was also noticed. The pulse rate was 120. blood pressure 110/80 mm H g and body temperature 39.9"C. Despite the patient's respiration being stable he was immediately admitted to the intensive care unit. Laboratory parameters on admission showed serum-CRP 110 mg/l (normal
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Streptococcal Myositis Lena Jahnson, Lars Berggren, Elisabet Björsell-ostling, Jan Bonnerstig & Hans Holmberg To cite this article: Lena Jahnson, Lars Berggren, Elisabet Björsell-ostling, Jan Bonnerstig & Hans Holmberg (1992) Streptococcal Myositis, Scandinavian Journal of Infectious Diseases, 24:5, 661-665, DOI: 10.3109/00365549209054654 To link to this article: http://dx.doi.org/10.3109/00365549209054654
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 7
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [RMIT University Library]
Date: 24 April 2016, At: 08:08
Scand J Infect Dis 24: 661-665, 1992 ~~
CASE REPORT
Streptococcal Myositis LENA JAHNSON', LARS BERGGREN', ELISABET BJORSELLOSlLING7. JAN BONNERSTIG4 and HANS HOLMBERG]
Downloaded by [RMIT University Library] at 08:08 24 April 2016
From the Departments of 'Infectious Diseases, 'Anaesthesia and Intensive Care, 'Regional Blood Cenrer and "OrthopredrcSurgery, Orebro Medical Center Hospital, Orebro. Sweden
Streptococcal myositis (SM), is a very serious condition with a high mortality rate. The port of entry of the infection is often unknown. We present here a case report concerning a 68-yearold patient with fulminant SM preceded by symptoms of an upper respiratory tract infection. Haemolytic streptococci of group A were found in the blood, muscle tissue and throat. The patient survived after massive therapeutic interventions including intensive care with intravenous antibiotics, fasciotomy, plasma exchange, controlled respirator ventilation and exarticulation through the shoulder. The patient's wife fell ill at the same time with a sore throat and the same type of streptococci (T-type 3) was found in both patients. L. Jahnson, M D , Department of Infectious Diseases, Orebro Medical Center Hospital, S-701 85 Orebro, Sweden
INTRODUCTION Streptococcal myositis (SM) is an unusual condition associated with a high mortality rate. Early diagnosis and treatment has, in certain cases, enabled its often fatal course to be halted. The cornerstones of therapy are considered to be aggressive surgery with immediate debridement. radical excision of necrotic tissue and appropriate antibiotic therapy. CASE REPORT A hX-year-old man who had enjoyed good health, fell abruptly ill on April 13 after just over a week of symptoms of a common cold. After a day of intensive physical labour (wood-chopping) he developed a temperature of 40°C and felt exhausted. The fever persisted and after 2 days pain suddenly developed in his right forearm. The pain increased and prevented him from sleeping. O n April 16 he went to his general practitioner and was sent from there to the emergency ward under the presumptive diagnosis of a muscle rupture. On admission at hospital the patient was in severe pain. The proximal portion of his forearm was markedly swollen. This swelling was less pronounced more distally. The forearm was slightly warm, almost board-like but without erythema. The radial pulse could be palpated normally whereas the ulnar pulsc was feeble. Initially movement of the wrist and fingers was good. In order to rule out bleeding or thrombosis an ultrasound examination was carried out. This demonstrated slightly swollen muscles of the forearm surrounded by fluid. but the findings were otherwise normal. O n renewed clinical examination approximately 5 h after admission, a faint, patchy erythema was noted on the volar forearm. Palpation of the forearm was nainful. The ulnar pulse could no longer be palpated and the radial pulse was weak. Flexion and abduction of the fingers and radial deviation of the wrist elicited severe pain. Superficial sensation on the ulnar aspect of the little finger was moderately diminished. O n attempting to make a fist there was a gap of 3 cm; a diminished capacity to flex the elbow was also noticed. The pulse rate was 120. blood pressure 110/80 mm H g and body temperature 39.9"C. Despite the patient's respiration being stable he was immediately admitted to the intensive care unit. Laboratory parameters on admission showed serum-CRP 110 mg/l (normal
