Case 159. Streptococcal myonecrosis (45 y-o M)
　 　 　 　 　
　 　 Debridment from progressive and lethal gangrene of both arms of a previously healthy man (clinical course: 3 days) 　 　
　 　 　 　 　
　 　
Key words : 
 Group A Streptococcus, Streptococcus pyogenes, streptococcal toxic shock-like syndrome, Fournier's gangrene, erysipelas 　 　
　 　 　
　
　 　 　
Massive growth of Gram-positive cocci is associated with pronounced gangrenous necrosis of soft tissue (HE). Cellular reaction is minimal. 　 Myonecrosis and dense infection of Gram-positive cocci are observed (HE).
Streptococcus pyogenes (group A Streptococcus) causing fatal progressive myonecrosis is called "man-eating bacteria".
　 　 　
　
　 　 　
Peripheral blood after microbial culture in the same case (Gram)
Short chains of Gram-positive cocci are morphologically typical of Streptococcus.　Streptococcal septicemia provokes streptococcal toxic shock-like syndrome. The bacteria are commonly sensitive to Penicillin, but the antibiotics administration is clinically ineffective because of the absence of blood stream.		 　 Reference case 159A
Necrotizing fasciitis in the leg of a 17 y-o female (HE, low power).　Streptococcal cellulitis provokes intractable skin ulceration. Massive necrosis of the skin and subcutaneous tissue is evident.
　 　 　
　
　 　 　
Reference case 159A
Necrotizing fasciitis in the leg of a 17 y-o female (HE, higher power).　Gangrenous change is evident in the soft tissue obtained by debridment.		 　 Reference case 159B
Fournier's gangrene of the scrotum of a 29 y-o male (HE).　Fournier's gangrene is a fatal gangrene involving the male scrotum and perineum . Mixed bacterial infection, including Streptococcus, is proven.
　 　 　
　 　
　 　 　
Reference case 159C
Erysipelas in the facial skin of a 19 y-o female (gross findings).　Erysipelas is non-ulcerating, diffuse cellulitis of the facial skin and soft tissue, caused by group A Streptococcus.