An elderly patient on haemodialysis with necrotising soft tissue infection of left upper limb

Necrotising fasciitis is one of the non traumatic orthopaedic/surgical emergencies where a multi-disciplinary team comprising of the surgeons, internal medicine physicians and the anaesthetists/ intensivists should be involved immediately to optimise the patient care in the perioperative period. We present a case of multifocal, non-contiguous pyomyositis in an elderly lady with multiple co-morbidities. The patient was treated with radical excisional debridement and was discharged well after 2 weeks of admission. This case is a diagnostic dilemma because patient was in septic shock with abscess over brachiocephalic fistula and severe tenderness in the distal half of forearm, which was not in continuity with the extent of abscess. Trauma does not appear to be an important association with pyomyositis, which is one of the rare variants of necrotising soft tissue infection. Also, as far as we can determine, this is potentially first case of suppurative pyomyositis arising from septic emboli seeding from an infective and partially thrombosed AVF.