PMC8714340_01
(a) Coronal images from a contrast CT of the thorax showing right latissimus dorsi muscle suggestive of deep tissue infection with possible muscle necrosis. (b) Coronal images from a contrast MRI of the thorax showing myonecrosis of the right latissimus dorsi muscle.
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A repeated CT of the right latissimus dorsi muscle (Figure 1(a)) suggested deep tissue infection with muscle necrosis, and a magnetic resonance tomography imaging (MRI) was also consistent with myonecrosis (Figures 1(b)).
Intraoperative images of the right latissimus dorsi muscle. Thickened and greenish fascia with underlying necrotic muscle.
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Upon surgical exploration, the fascia of the right latissimus dorsi muscle was found to be greenish and thickened, and the underlying muscle was necrotic with an absence of bleeding and contractility upon stimulation (Figure 2), but without smell or gas release.
(a) Trephine biopsy showing markedly hypocellular bone marrow, with 5-10% cellularity. (b) Trephine biopsy showing a significant increase of bone marrow cellularity after treatment with IST.
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The trephine biopsy showed hypocellular bone marrow (only 5-10% cellularity, Figure 3(a)) with only a small number of lymphocytes and plasma cells, and complete absence of both megakaryocytes, myelopoiesis, and erythropoiesis. A new bone marrow biopsy showed a significant increase of the cellularity with detectable haematopoiesis as signs of regeneration (Figure 3(b)).