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Buttock Pain*

History: A female in her 40’s presents to the ED for 3 days of generalized malaise and worsening left buttock pain with subjective fevers. She denies any abdominal pain but did vomit once. She denies chills or any other complaints.

Exam: Vital signs were a bit soft: pulse 102, BP 92/51 with a shock index >1.0 (HR/SBP).   Physical exam was otherwise normal except for a red swollen left buttock

Testing:

  • WBC = 17 with 16 bands.
  • Lactic acid = 2.6
  • CT: See image

What’s the most likely diagnosis?

  1. Cellulitis
  2. Abscess
  3. Necrotizing Fasciitis
  4. Pyomyositis

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ANSWER: #3: Necrotizing Fasciitis.  The case image shows necrotizing fasciitis in the left buttock with subcutaneous air

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E-meducation page-shot for educational topic for this case from the Emergency Medicine 1-Minute Consult Pocketbook

CASE CONCLUSION: This patient went to the OR and did well… eventually.  There was a prolonged hospitalization.

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