Nontraumatic compartment syndrome is frequently difficult to diagnose but this is especially troublesome in infants. Pain is the most sensitive sign and is characteristically severe and refractory to routine analgesia. Failure to diagnose and treat can lead to disability, multiorgan failure, and death. Surgical intervention is crucial and includes emergent fasciotomy, debridement, nerve decompression, and later skin grafting. Streptococcal myositis causing compartment syndrome is more likely in the immunocompromised patient.
Congenital hemangiomas are rare, benign vascular tumors that present fully grown at birth.
Case report and literature review.
This case report details a healthy child, with a resolving congenital hemangioma of the forearm, presenting with toxic shock syndrome and a streptococcal myositis creating a compartment syndrome in the same forearm after an upper respiratory tract infection. The child underwent an emergent fasciotomy and debridement of the arm. Profound systemic effects necessitated transfer to intensive care unit and continuing postoperative mechanical ventilation, inotropic support, intravenous antibiotics, and immunoglobulin administration. Postoperatively, blood cultures and wound biopsies were all positive for Beta Hemolytic Group A Streptococci. Several days later, after a course of antibiotics, the volar forearm was closed with meshed split thickness skin grafts with good graft take. In our patient, we concluded that the hemangioma may have acted as a locus to attract the hematogenous spread of the streptococcal infection from the throat and caused a soft tissue infection that led to massive edema of the limb and consequently to compartment syndrome.
From the Kaplan Medical Center Derech Pasternak Rehovot 76100 Israel.
Disclosure: The author declares no conflict of interest.
Reprints: Sharon L. Kracoff, MD, Kaplan Medical Center Derech Pasternak Rehovot 76100 Israel (e-mail: email@example.com).