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• W2516176435 abstract "A 25-year old man presented to the Accident and Emergency department with a 4-day history of severe left hip and buttock pain on a background of several months of excessive sweating. He had no previous medical history and, specifically, no history of antecedent trauma to the hip. On examination he was febrile with massive splenomegaly and an extremely tender swelling over the hip with no erythema or palpable crepitus. The white cell count was 350·3 × 109/l with a haemoglobin concentration of 60 g/l and a platelet count of 337 × 109/l. Blood film and bone marrow trephine biopsy findings were compatible with chronic phase chronic myeloid leukaemia, with cytogenetic analysis showing 46,XY, t(9;22)(q34;q11). Ultrasound and computed tomography showed an extensive heterogeneous collection (11 × 9 × 5 cm) within the left gluteal and posterior thigh muscles, within which were contained multiple pockets of gas (left image). He underwent immediate exploration and washout and, intra-operatively, was found to have large amounts of pus with healthy appearing surrounding muscle tissue. On day one post-operatively, he deteriorated acutely, with sepsis, and magnetic resonance imaging revealed extensive collections remaining with liquefaction and necrosis of the normal muscle compartments. Surgical re-exploration showed widespread myonecrosis of the left gluteus medius, hamstrings and adductor muscles, for which he underwent life-saving left hindquarter amputation. Cultures from blood, surgical swabs and aspirated pus remained negative although he had been treated with multiple broad-spectrum antibiotics since admission. Muscle biopsy sections did not show any microorganisms but revealed a thrombosed artery within infarcted skeletal muscle that was infiltrated by neutrophils (right image). There was no evidence of vasculitis and an autoantibody screen was negative. Following multiple stump washouts, the patient recovered well and was discharged with a leg prosthesis. He was commenced on a tyrosine kinase inhibitor and attained a major molecular remission. Although myonecrosis has been reported in acute leukaemias, it is very rare in chronic myeloid leukaemia. We hypothesise that in this patient Clostridium septicum, the most common cause of spontaneous myonecrosis, was seeded from an occult gastrointestinal source to the skeletal muscle of the posterior thigh and resulted in infection with an inflammatory response. As a consequence of this, thrombosis and infarction occurred, in addition to leucostasis. Myonecrosis may be a rare complication of leucostasis in a muscle despite lack of any other predisposing factors or trauma." @default.
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• W2516176435 date "2016-08-12" @default.
• W2516176435 modified "2023-09-23" @default.
• W2516176435 title "Spontaneous myonecrosis in chronic myeloid leukaemia" @default.
• W2516176435 doi "https://doi.org/10.1111/bjh.14278" @default.
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