Department of Emergency Medicine, Saint Agnes Medical Center, Fresno, CA, USA.
Department of Surgery, Saint Agnes Medical Center, Fresno, CA, USA.
Am J Case Rep. 2021 Mar 12;22:e929176. doi: 10.12659/AJCR.929176.
BACKGROUND Acute compartment syndrome represents a surgical emergency to restore blood supply by fasciotomy and decompression. Compartment syndrome is most commonly associated with crush-related injuries and fractures; however, other non-traumatic etiologies can occur. This report illustrates a rare case of acute atraumatic compartment syndrome of the upper extremity due to Streptococcus pyogenes cellulitis in an 84-year-old man, presenting a challenging clinical scenario. CASE REPORT An 84-year-old man presented to the Emergency Department with 24 h of significant right-arm pain and swelling. Due to the amount of increased swelling and significant pain, compartment pressure was obtained. He underwent emergency fasciotomy of his right forearm, hand, and carpal tunnel release. Both blood and intraoperative wound cultures grew Streptococcus pyogenes (Group A Streptococcus). The patient suffered a prolonged hospital course requiring multiple subsequent surgeries and eventual skin grafting. Despite his complicated hospital course, he made a remarkable recovery and was discharged home in excellent condition. CONCLUSIONS This report illustrates that compartment syndrome should be considered as a complication of cellulitis in patients with severe pain, even without a history of trauma. Early diagnosis, antibiotic therapy, and emergency fasciotomy are required to preserve the affected limb.
急性间隔综合征是一种通过筋膜切开术和减压来恢复血液供应的外科急症。间隔综合征最常与挤压相关损伤和骨折有关；然而，也可能发生其他非创伤性病因。本报告介绍了一例罕见的 84 岁老年男性因化脓性链球菌蜂窝织炎引起的上肢急性非创伤性间隔综合征的病例，提出了一个具有挑战性的临床情况。
一名 84 岁男性因右臂疼痛和肿胀 24 小时就诊于急诊科。由于肿胀程度和疼痛明显增加，因此进行了间隔压力测量。他接受了右前臂、手部和腕管的紧急筋膜切开术。血液和术中伤口培养均生长出化脓性链球菌（A 组链球菌）。患者经历了漫长的住院过程，需要多次后续手术和最终植皮。尽管他的住院过程复杂，但他恢复得非常好，出院时情况良好。
本报告表明，对于有严重疼痛的蜂窝织炎患者，即使没有创伤史，也应考虑间隔综合征是其并发症之一。早期诊断、抗生素治疗和紧急筋膜切开术是保存受累肢体所必需的。
