An 84-Year-Old Man with Acute Atraumatic Compartment Syndrome of the Upper Extremity Due to Streptococcus pyogenes Cellulitis
Unusual clinical course, Challenging differential diagnosis
Carly A. Robinson, Jesse Z. Kellar, Ryan C. Stehr
Department of Emergency Medicine, Saint Agnes Medical Center, Fresno, CA, USA
Am J Case Rep 2021; 22:e929176
Available online: 2021-02-03
Acute compartment syndrome represents a surgical emergency to restore blood supply by fasciotomy and decompression. Compartment syndrome is most commonly associated with crush-related injuries and fractures; however, other non-traumatic etiologies can occur. This report illustrates a rare case of acute atraumatic compartment syndrome of the upper extremity due to Streptococcus pyogenes cellulitis in an 84-year-old man, presenting a challenging clinical scenario.
CASE REPORT: An 84-year-old man presented to the Emergency Department with 24 h of significant right-arm pain and swelling. Due to the amount of increased swelling and significant pain, compartment pressure was obtained. He underwent emergency fasciotomy of his right forearm, hand, and carpal tunnel release. Both blood and intraoperative wound cultures grew Streptococcus pyogenes (Group A Streptococcus). The patient suffered a prolonged hospital course requiring multiple subsequent surgeries and eventual skin grafting. Despite his complicated hospital course, he made a remarkable recovery and was discharged home in excellent condition.
CONCLUSIONS: This report illustrates that compartment syndrome should be considered as a complication of cellulitis in patients with severe pain, even without a history of trauma. Early diagnosis, antibiotic therapy, and emergency fasciotomy are required to preserve the affected limb.
Keywords: Cellulitis, Compartment Syndromes, Streptococcus pyogenes, case reports