Spontaneous gangrenous myositis induced by Streptococcus pyogenes: case report and review of the literature.

A 54-year-old man presented with gangrenous myositis caused by Streptococcus pyogenes. A review of the literature disclosed 10 similar cases. Their presenting manifestations were spontaneously occurring, localized, excruciating pain; mottling suggestive of ischemic changes; and signs of sepsis. The duration of illness ranged from two to six days, and the outcome was uniformly fatal. This rare but distinct entity resembles clostridial myonecrosis except that it lasts slightly longer and does not involve gaseous crepitus. A definitive diagnosis of myonecrosi scan be established by surgical exploration; early, radical debridement plus penicillin therapy should be undertaken after diagnosis in an attempt to alter the usual devastating outcome.