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Severe, Steroid-responsive, Myositis Mimicking Necrotizing Fasciitis following Orthopedic Surgery: A Pyoderma Variant with Myonecrosis

Reid, Alistair B. FRACP*†; Stanley, Peter FRACP; Grinsell, Damien FRACS§; Daffy, John R. FRACP

Plastic and Reconstructive Surgery - Global Open: June 2014 - Volume 2 - Issue 6 - p e175
doi: 10.1097/GOX.0000000000000124
Case Reports
Australia

Summary: Postoperative pyoderma gangrenosum is a rare neutrophilic dermatosis that may be confused for necrotizing fasciitis. The inflammatory response is triggered by the trauma of surgery and thus must be managed nonsurgically. Clinical and pathological findings in the 2 diseases can be identical, leading to misdiagnosis and massive surgical defects from the ensuing surgery. This report documents a severe case of postsurgical pyoderma following an elective rotator cuff repair presenting with myositis and myonecrosis. The patient was initially treated as having an infection, which resulted in multiple aggressive surgical debridements. Despite this, the patient continued to deteriorate and was in a critical and hemodynamically unstable condition. Following administration of high-dose intravenous corticosteroids, the patient made a dramatic recovery and went on to have internal fixation of the shoulder and closure of the wound with a combination of a free flap and a rotational flap. Extensive myositis, as seen in this case, has not been previously reported in postoperative pyoderma gangrenosum variants. Clinicians should be aware that the presence of myositis and myonecrosis should not preclude this diagnosis.

From the *Infectious Diseases Unit, Wollongong Hospital, NSW, Australia; University of Wollongong, NSW, Australia; Infectious Diseases Unit, St Vincent’s Hospital Melbourne, VIC, Australia; and §Plastic Surgery Department, St Vincent’s Hospital Melbourne, VIC, Australia.

Received for publication February 10, 2014; accepted April 29, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the Wollongong Hospital research unit.

Alistair B. Reid, FRACP, Infectious Diseases Department, Level 1, Lawson House, Wollongong Hospital, Crown Street, Wollongong, NSW 2500, Australia, E-mail: alistair.reid@sesiahs.health.nsw.gov.au

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© 2014 American Society of Plastic Surgeons