Streptococcal myositis and tissue necrosis with intramuscular administration of diclofenac

The authors describe a fatal case of a group A beta-haemolytic streptococci infection. The symptoms seemed to have been initiated by minor skin trauma; intramuscular injections of diclofenac (Voltaren) and metoclopramide (Primperan) after which the patient developed extensive muscle necrosis. The clinical course was rapid and he died within 48 hours after the first injection from circulatory collapse, probably due to overwhelming septicaemia with group A beta-haemolytic streptococci. Streptococcal myositis is a rare and extremely serious complication of skin trauma. Muscle necrosis is also a known but rare side effect of intramuscular administration of drugs (the "Nicolau syndrome") in which non-steroid anti-inflammatory drugs are often implicated. The case is discussed in the context of this specific syndrome.