Atypical ill-defined process of the left axilla on CT scan, representative of myositis and fasciitis

Abstract

Presentation
A previously healthy, 42-year-old female patient presented to the Emergency Department with a five-day history of widespread urticarial rash. The patient complained of widespread joint pain with bilateral upper limb oedema noted on clinical examination.

Diagnosis
Core bloods revealed raised WCC and CRP. CT chest and neck were performed which revealed an 8mm left supraclavicular node with haziness of the surrounding fat along with low attenuation extending between the left deltoid and infraspinatus muscles (Figure 1). The CT radiological findings were atypical and MRI with Gadolinium contrast was recommended which confirmed the diagnosis of myositis and fasciitis.

Treatment
Intravenous glucocorticoid therapy along with broad spectrum antimicrobial treatment were provided with clinical improvement over a six-day period.

Discussion
This case highlights both the limitations of radiological imaging in isolation and the importance of interdisciplinary collaboration to provide an appropriate diagnosis and management plan. This patient improved clinically following combined treatment for both inflammatory and infectious aetiology while more advanced diagnostics were performed over a protracted time period.