Case Report

Right Arm Pyomyositis and Necrotizing Fasciitis Complicated With Subcutaneous Emphysema and Pneumomediastinum in a Patient With Diabetes Mellitus and Iatrogenic Cushing Syndrome

Authors: Chen-Hsiang Lee, MD, Jien-Wei Liu, MD

Abstract

We report a case of subcutaneous emphysema and pneumomediastinum secondary to pyomyositis and necrotizing fasciitis over the right arm of a woman with underlying diabetes mellitus and iatrogenic Cushing syndrome. Gas produced by the culprit pathogen extensively dissected the subcutaneous fat and fascia of the patient’s right arm and distantly spread to her face, neck, back, and thoracic wall and penetrated the soft tissue cephalically bordering her sternum, resulting in pneumomediastinum. The patient improved with antimicrobial therapy and localized debridement and fasciotomy over her right arm.


Key Points


* Pyomyositis and necrotizing fasciitis of the right arm led to subcutaneous emphysema and pneumomediastinum in a diabetic patient with iatrogenic Cushing syndrome.


* Localized debridement and fasciotomy over the right arm coupled with antibiotic therapy cured the patient, and the pneumomediastinum disappeared.

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