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Case Reports
. 2023 Jun 2:24:e939538.
doi: 10.12659/AJCR.939538.

Streptococcal pharyngitis in a Child, Complicated with a Necrotizing Myositis: Diagnosis, Management and Follow-Up

Boštjan Pirš  1   2 , Tina Kunič  3   2 , Nadja Alikadič  4   4
Affiliations
Case Reports

Streptococcal pharyngitis in a Child, Complicated with a Necrotizing Myositis: Diagnosis, Management and Follow-Up

Boštjan Pirš et al. Am J Case Rep. .

Abstract

BACKGROUND Group A streptococcus is a common cause of pharyngitis and can also cause a wide variety of invasive infections, including necrotizing soft-tissue infections. The presented case is one of the rare occurrences of necrotizing soft-tissue infection as a consequence of hematogenous spread and is the first described pediatric case of streptococcal myositis that was clearly preceded by pharyngitis. CASE REPORT A 2.5-year-old boy, previously healthy, fell ill 3 days before admission with high-grade fever, diffuse erythematous truncal rash and, later, with pain in the left lower leg. The next day, scarlet fever was diagnosed, and he was started on oral penicillin V. In the following 2 days, the fever and pain in the leg did not subside; edema and redness of the left shin appeared. On admission, he was febrile and had tachycardia, and the mouth examination was consistent with bacterial pharyngitis. The left shin was grossly edematous, with diffuse bluish skin discoloration. Empiric antibiotic treatment with benzylpenicillin and clindamycin was started. An ultrasound scan of the left shin revealed extensive myonecrosis. Urgent fasciotomy was done, and necrotic muscles were surgically excised. CONCLUSIONS Streptococcal necrotizing myositis is exceedingly rare. Due to potentially life-threatening complications and a need for urgent surgical intervention, clinicians must have a low threshold of suspicion, even in atypical pathogenesis and presentation.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Photograph of both lower legs at the time of the admission showing swelling and bluish skin discoloration of the left shin.
Figure 2.
Figure 2.
Muscular necrosis in the course of musculus tibialis anterior and extensor digitorum longus on the left shin.
Figure 3.
Figure 3.
The wound after radical surgical debridement in the anterolateral compartment of the left shin.
Figure 4.
Figure 4.
Healed wound on the left shin 4 months after urgent fasciotomy and debridement of necrotic muscle.
See this image and copyright information in PMC

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