Necrotizing myositis

Background

• Much rarer than Necrotizing fasciitis
• May be preceded by skin abrasions, blunt trauma, heavy exercise
• Most patients are otherwise healthy (DM and other underlying conditions do not appear to increase risk)

Clinical Features

• Exquisite pain and swelling of affected muscle with induration
• Overlying skin changes may manifest later in the course of illness (erythema, warmth, petechiae, bullae)
• Hypotension may occur rapidly with development of streptococcal toxic shock syndrome

Differential Diagnosis

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Necrotizing rashes

• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Purpura fulminans
• Drug rash
• Levamisole toxicity
• Heparin-induced skin necrosis
• Warfarin-induced skin necrosis

Management

• Same as Necrotizing Fasciitis

Disposition

• Admit/OR

See Also

• Necrotizing soft tissue infections