Streptococcal pharyngitis in a Child, Complicated with a Necrotizing Myositis: Diagnosis, Management and Follow-Up.

BACKGROUND Group A streptococcus is a common cause of pharyngitis and can also cause a wide variety of invasive infections, including necrotizing soft-tissue infections. The presented case is one of the rare occurrences of necrotizing soft-tissue infection as a consequence of hematogenous spread and is the first described pediatric case of streptococcal myositis that was clearly preceded by pharyngitis. CASE REPORT A 2.5-year-old boy, previously healthy, fell ill 3 days before admission with high-grade fever, diffuse erythematous truncal rash and, later, with pain in the left lower leg. The next day, scarlet fever was diagnosed, and he was started on oral penicillin V. In the following 2 days, the fever and pain in the leg did not subside; edema and redness of the left shin appeared. On admission, he was febrile and had tachycardia, and the mouth examination was consistent with bacterial pharyngitis. The left shin was grossly edematous, with diffuse bluish skin discoloration. Empiric antibiotic treatment with benzylpenicillin and clindamycin was started. An ultrasound scan of the left shin revealed extensive myonecrosis. Urgent fasciotomy was done, and necrotic muscles were surgically excised. CONCLUSIONS Streptococcal necrotizing myositis is exceedingly rare. Due to potentially life-threatening complications and a need for urgent surgical intervention, clinicians must have a low threshold of suspicion, even in atypical pathogenesis and presentation.

Review of calciphylaxis and treatment of a severe case after kidney transplantation with iloprost in combination with hyperbaric oxygen and cultured autologous fibrin-based skin substitutes.

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication in patients with end-stage renal disease as well as in patients after renal transplantation. It should be suspected in patients with typical painful violaceous skin lesions on the extremities or on the trunk. Active multidisciplinary management approach, with intensive local wound care, is vital in these patients. Controlling parathyroid hormone, hyperbaric oxygenation, sodium thiosulphate, bisphosphonates, cinacalcet and skin grafting could be effective. In our report, we describe a case of CUA in a 43-year-old patient two years after kidney transplantation. Despite intensive standard treatment, his wounds progressed; therefore, we decided to use iloprost, in combination with hyperbaric oxygenation. The clean wounds were then covered with cultivated autologous skin cells to enhance wound epithelialization. Seven months after finishing iloprost and hyperbaric oxygen treatment and the first application of skin substitute, the wounds healed completely and remained healed during the four-yr follow-up period. We conclude that in patients with severe CUA-induced wounds, the combined treatment with iloprost, hyperbaric oxygen and autologous cultured fibrin-based skin substitutes can be effective. A combination of different treatment modalities is vital in patients with CUA.