Kujath P, Krüger S, Bechtold H, Eckmann C
Klinik für Chirurgie, Universitätsklinikum Lübeck, Germany.
Dtsch Med Wochenschr. 2002 Nov 22;127(47):2508-10. doi: 10.1055/s-2002-35644.
Case 1: Following an influenza a 40-year-old patient was treated by intramuscular injections for backache. 24 hours later he was admitted to a hospital with massive pain in both lower extremities and a markedly reduced general condition. Case 2: Two days after a knee joint arthroscopy a 57-year-old man developed strong pain in the extremity treated by application of diclofenac. On the following day the patient was admitted to a university hospital in a septic state with a swollen, cold and blurry changed extremity.
The myoglobin concentration was dramatically increased in both cases (> 15 000 mg/l). CRP values were elevated. The progressive septic state with acute renal failure was verified by elevation of creatinine concentration and decrease of leukocyte values in the second case (from 10/nl to 2,5/nl) shortly after admission.
DIAGNOSIS, TREATMENT AND COURSE: Both the patients died for septic shock. Case 1 died shortly after admission before surgical intervention. The second patient developed rapid progression of the myositis including the trunk despite radical surgical treatment (hip joint exarticulation).
In cases of sudden and painful swelling of an extremity of unknown origin or following intramuscular injection streptococcal myositis has to be taken into account. Only an immediate surgical intervention up to amputation of the affected extremity can stop the fatal course.
病例1：一名40岁患者在感染甲型流感后因背痛接受肌肉注射治疗。24小时后，他因双下肢剧痛和全身状况明显恶化而入院。病例2：一名57岁男性在膝关节关节镜检查两天后，在使用双氯芬酸治疗的肢体出现剧痛。次日，患者因感染性休克状态入院，治疗肢体肿胀、冰冷且有模糊变化。
两例患者的肌红蛋白浓度均显著升高（>15000mg/L）。CRP值升高。在第二例患者入院后不久，肌酐浓度升高和白细胞值下降（从10/μl降至2.5/μl）证实了伴有急性肾衰竭的进行性感染性休克状态。
诊断、治疗与病程：两名患者均死于感染性休克。病例1在入院后不久、手术干预前死亡。第二例患者尽管接受了根治性手术治疗（髋关节离断术），但包括躯干在内的肌炎仍迅速进展。
在不明原因的肢体突然疼痛肿胀或肌肉注射后，必须考虑链球菌性肌炎。只有立即进行手术干预直至截肢受影响肢体，才能阻止致命病程。
