Treatment of Atypical Compartment Syndrome Due to Proteus Infection

Abstract

Compartment syndrome is an orthopedic emergency with a multitude of etiologies. Although it is most commonly associated with trauma to the extremity, hematoma and infection are 2 rare etiologies of insidious compartment syndrome. Proteus mirabilis is an opportunistic gram-negative species that can infect the respiratory tract, urinary tract, and open wounds. The authors present the case of a 69-year-old woman who developed tissue necrosis and compartment syndrome secondary to an untreated hematoma infected by P mirabilis. This case involves an atypical presentation caused by an untreated infected hematoma, emphasizing the need for a high index of suspicion. Current literature supports immediate surgical intervention in the clinical scenario of fulminant compartment syndrome, regardless of compartment pressure findings. The probability of compartment syndrome in the patient presenting with pain, paresthesias, paresis, and pain with passive stretch, all of which were positive findings in this patient, has been reported to be 98%. Thus, Doppler evaluation and intercompartmental pressures were considered but forgone to expedite operative treatment. Emergent 4-compartment fasciotomies, with excision and debridement of nonviable tissue, are potentially limb-saving procedures, intended to limit loss of function and obviate the need for lower extremity amputation. The decision was made to perform a dual-incision fasciotomy to avoid contamination of the uninvolved compartments with a standard single-incision approach. To date, this represents the first report in the English literature of the insidious onset of tissue necrosis secondary to a Proteus-infected hematoma, highlighting a unique etiology of atypical compartment syndrome. [Orthopedics. 2017; 40(1):e176-e178.].

Atypical compartment syndrome of the forearm due to mixed infection with Proteus mirabilis and Morganella morganii after a penetrating injury: A limb-saving approach

“…[ 13 ] Current literature suggests that surgical fasciotomy of the involved compartments remains the gold-standard treatment approach, irrespective of the cause, condition, or location. [ 14 ] Stull et al[ 7 ] performed dualincision fasciotomy instead of a standard singleincision to avoid contamination of the uninvolved compartments in a patient with ACS secondary to a Proteus-infected hematoma. However, we decided to use a standard single-incision approach for our patient.…”

“…The literature review shows that unusual anatomical locations, rare conditions, drug interactions, and their side effects as well as surgical procedures and rare fractures can be associated with ACS. [ 7 , 13 , 14 ] There is limited knowledge about an infected hematoma associated with ACS,[ 7 ] and the authors of this case report describe a coinfection of forearm hematoma leading to ACS for the first time in the literature. [ 15 ] Proteus mirabilis and M. morganii were isolated as coinfectious agents in this case.…”

“…[ 6 ] Hematoma and infection are two rare causes that may play a role in the development of ACS, and a case of ACS secondary to Proteus mirabilis (P. mirabilis) -infected hematoma has been reported in the literature. [ 7 ] However, to the best of our knowledge, our case is the first report of ACS caused by a subcutaneous hematoma coinfected with P. mirabilis and Morganella morganii (M. morganii) .…”

Unusual Presentation of Compartment Syndrome

“…Apart from that, rare infections can cause the entity. Last year, Stull et al reported the case of a 6-year-old man treated for compartment syndrome caused by Proteus-infected hematoma of the lower leg [29].…”