Department of Plastic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2020 Jan;90(1-2):130-134. doi: 10.1111/ans.15429. Epub 2019 Sep 14.
Necrotizing myositis (NM) is a life-threatening emergency. It causes focal muscle necrosis without abscess formation or extensive involvement of the overlying fascia and soft tissue. It is a clinical diagnosis requiring a high index of clinical suspicion. Usual presentation can readily be mistaken to represent more benign pathologies such as muscular injury, viral myopathy or deep venous thrombosis. The clinical course following initial misdiagnosis is rapid deterioration into profound sepsis and progressive multiorgan failure. Prompt treatment is associated with favourable outcomes, but early diagnosis is challenging due to initial absence of cutaneous signs and symptoms. Delayed referral to surgeons with appropriate expertise results in higher morbidity and mortality. The cornerstones to treatment are complete surgical debridement, intensive care management and accurate antimicrobial therapy.
We report four cases of NM demonstrating classical scenarios of initial misdiagnosis, delays in referral and review by an experienced surgeon. A review of the current literature to aid with overall management is also included.
Review of literature that revealed the most common presentation was antecedent prodromal flu-like symptoms followed by rapidly progressing focal muscle pain. Patients were initially misdiagnosed followed by rapid deterioration into profound sepsis before surgical opinion was obtained.
NM is a rare and potentially fatal disease that must be considered in the differential diagnoses of the young, healthy patient with acute limb pain and fever. A high index of suspicion will facilitate earlier management and reduce morbidity and mortality.
坏死性肌炎（NM）是一种危及生命的紧急情况。它会导致局部肌肉坏死，不会形成脓肿，也不会广泛累及覆盖的筋膜和软组织。这是一种临床诊断，需要高度的临床怀疑。通常的表现很容易被误认为是更良性的病理，如肌肉损伤、病毒性肌病或深静脉血栓形成。在最初误诊后，临床病程迅速恶化，导致严重败血症和进行性多器官衰竭。及时治疗与良好的预后相关，但由于最初缺乏皮肤症状和体征，早期诊断具有挑战性。由于缺乏相关专业知识，外科医生的延迟转诊导致发病率和死亡率更高。治疗的基石是彻底的外科清创、重症监护管理和准确的抗菌治疗。
我们报告了四起 NM 病例，这些病例表现为最初误诊、延迟转诊和有经验的外科医生复查的典型情况。还包括对当前文献的回顾，以帮助进行整体管理。
文献回顾显示，最常见的表现是前驱性流感样症状，随后是迅速进展的局部肌肉疼痛。患者最初被误诊，随后迅速恶化，出现严重败血症，然后才获得外科意见。
NM 是一种罕见且潜在致命的疾病，在年轻、健康的急性肢体疼痛和发热患者的鉴别诊断中必须考虑到。高度怀疑将有助于更早地进行管理，并降低发病率和死亡率。
