Rapidly fatal tropical pyomyositis in a elderly diabetic woman

Abstract Necrotizing soft tissues infections, with or without myositis, are classified among the most dangerous infectious emergencies in clinical practice. The authors report a case of an older diabetic women who presented to the orthopedic service with right elbow pain after a small trauma with skin abrasion, released with analgesic prescription. After 48 hours she presented to the emergency room with an history of developing bullous and necrotic lesions in the right upper limb, hypotension and numbness, with rapid and fatal evolution despite adequate clinical and surgical therapeutic support. Muscle biopsy showed necrotizing myositis. Blood culture was positive for Panton Valentine leukocidin producing (PVL-positive) methicillin-resistant S. aureus. Although PVL has a strong epidemiologic association with Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, it can also be found in CA-MSSA in the context of necrotizing pneumonia and skin and soft tissues infections. CA-MRSA or CA-MSSA PVL + infections, although infrequent, should always be suspected in high risk patients because it can rapidly evolve with severe, sometimes fatal complications.