Rapidly Progressive Necrotizing Soft Tissue Infection of the Chest Wall After Skeletal Muscle Injury in a Healthy Young Adult Leading to Death: A Case Report.
Colin Rivet, Yamuna Carey, Tovy Kamine
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Case in brief
A previously healthy 28-year-old man presented with right shoulder and chest wall pain and was initially diagnosed with muscle strains on MRI. Five days later, he returned with hypotension; blood cultures grew Streptococcus pyogenes, and imaging showed extensive soft-tissue involvement. Emergency fasciotomy and serial debridement identified a necrotizing soft-tissue infection extending from the right shoulder to the scrotum and opposite shoulder. Despite antibiotics, repeated debridement, renal replacement therapy, and vasopressors, he developed multiorgan failure and died within 24 hours of ICU admission.
What made this case unusual
The infection initially resembled muscle strain in a healthy young adult, yet progressed extensively from the shoulder and chest wall to distant sites, including the scrotum and contralateral shoulder.
Diagnostic / clinical pearl
Severe or worsening pain attributed to muscle strain should be reassessed if the clinical course changes; necrotizing soft-tissue infection can progress rapidly and present atypically, even in a previously healthy young adult.