Multifocal pyomyositis in an immunocompetent patient

Multifocal extraocular muscle pyomyositis: A case report and review of literature

Pyomyositis is a rare condition which occurs most often in large skeletal muscles. Pyomyositis of extraocular muscles is a very rare entity. The authors describe a case of 2 sites of pyomyositis of extraocular muscles. A 20-year-old man presented with right periocular pain, redness, and proptosis for 1 week.Computed tomography showed well-circumscribed masses with enhancing rims in the medial and inferior rectus muscles. The patient underwent orbital drainage surgery and received an intravenous antibiotic. Haemoculture and pus culture could not identify an organism. Systemic steroid was administered after the infection was controlled, in regard to scar prevention.

Temperate pyomyositis: a pain in the belly

Pyomyositis is a rare disease in temperate climates. This case is a unique presentation of pyomyositis of the rectus abdominal muscle mimicking an acute abdominal process. Most reported cases of pyomyositis are of extremity infections with Staphylococcus aureus.This report presents a case of polymicrobial pyomyositis from Haemophylus parainfluenza and Steptococcus viridians infection.

Bilateral obturator pyomyositis with visceral involvement in an immunocompetent adult patient treated without surgery

BACKGROUND

Primary pyomyositis is a rare bacterial infection that affects large muscle groups mainly in immunocompromised patients. Treatment options include antibiotic treatment with surgical or radiologic interventions.

CASE

A 22-year-old immunocompetent athlete was diagnosed with bilateral obturator muscle pyomyositis involving pelvic floor muscles and the urinary bladder after muscle injury during training. Intravenous antibiotic treatment was administered, resulting in eradication of the infection.

CONCLUSION

This is the first case of bilateral obturator pyomyositis with coexisting involvement of pelvic floor muscles (levator ani) and viscera (urinary bladder) treated exclusively and with success by the administration of appropriate antibiotic therapy. A non-operative approach may could be attempted for the avoidance of postoperative morbidity and complications, especially when early clinical suspicion and diagnostic work-up lead to early diagnosis.

(18)F-FDG Positron Emission Tomography in Multifocal Pyomyositis

¹⁸F-Fluoro-deoxyglucose–positron emission tomography/computed tomography findings in a case presenting with pyomyositis are presented in this report.

Pyomyositis in children: early diagnosis and treatment

PURPOSE

This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis.

METHODS

Between 2001 and 2006, 6 children with a mean age of 7.2 years were diagnosed and treated for pyomyositis in our clinic. The most common site of involvement was the hip and thigh region. All patients underwent early magnetic resonance imaging (MRI) examination that played a significant role in the early diagnosis and management of the disease.

RESULTS

Staphylococcus aureus was the most common pathogen and was identified in 3 cases. Intravenous antibiotics were administered and were followed by oral agents for an additional period. The duration of therapy ranged from 3 to 6 weeks. No surgical intervention was needed. Magnetic resonance imaging was used to evaluate response to the therapy.

CONCLUSIONS

Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis.

Primary erector spinae pyomyositis causing an epidural abscess: case report and literature review

BACKGROUND CONTEXT

Primary pyomyositis (PM) is a rare bacterial infection of skeletal muscle usually restricted to tropical zones. Typically caused by Staphylococcus aureus, primary staphylococcal PM associated with an epidural abscess has not been reported before.

PURPOSE

We present the first case of staphylococcal PM associated with an epidural abscess.

STUDY DESIGN

Case report.

PATIENT SAMPLE

A 56-year-old woman.

OUTCOME MEASURES

Clinical follow-up at 9 months.

METHODS

This 56-year-old woman presented with a sudden onset of left lumbar back pain and sciatica without prior illness. She was pyrexial on admission, with elevated inflammatory markers but with no obvious systemic source of sepsis.

RESULTS

Spinal magnetic resonance imaging and subsequent surgery revealed an erector spinae abscess causing an epidural abscess via the left L4/5 intervertebral foramen. Both back pain and sciatica were immediately improved postoperatively. Culture revealed S aureus as the sole organism sensitive to flucloxacillin. Intravenous therapy was converted to oral after 12 days once the erythrocyte sedimentation rate had normalized and she was asymptomatic. She remains asymptomatic and without clinical signs at the 9-month follow-up.

CONCLUSION

Spinal infection must always be considered when back pain and sciatica are associated with clinical signs of sepsis. We present the first case of staphylococcal PM associated with an epidural abscess.

A pediatric case of pyomyositis presenting with septic pulmonary emboli

Pyomyositis is a suppurative infection of skeletal muscle most commonly caused by Staphylococcus aureus. It is mainly encountered in children and immunocompromised. Eight year old previously healthy girl presented with confusion, fever and swelling of the right knee two days after a trauma. Abdominal ultrasonography and computerized tomography taken upon development of hematemesis revealed no pathology in the abdomen, but potential bleeding sites in lung sections. Thorax CT images were interpreted in favor of septic pulmonary emboli due to the presence of peripheral nodular consolidation areas with central cavitation, mostly pathchy in medial areas. S. aureus was isolated in the blood culture. At the end of third week of hospitalization, gadolinium enhanced contrast MRI of right extremity was taken to evaluate right extremity swelling and revealed abscess formation as expected in the clinical progress of pyomyositis. Pyomyositis and septic pulmonary emboli are a rare association. This case demonstrates that the high index of suspicion in pediatric cases with muscle findings and septic pulmonary findings and early institution of therapy may improve the prognosis.

Tropical and Temperate Pyomyositis

Pyomyositis is a primary infection of skeletal muscle not arising from contiguous infection, presumably hematogenous in origin, and often, but not invariably, associated with abscess formation. Classically, pyomyositis is an infection of the tropics, occurring in previously active and healthy young men. Pyomyositis in temperate countries is often regarded as an infection that occurs in hosts who are immunocompromised or otherwise debilitated. However,this distinction may be somewhat artificial, as tropical pyomyositis may be partly related to underlying infection with HIV or parasites, and temperate pyomyositis has been reported in healthy and athletic persons. This article discusses the pathogenesis, clinical presentation, diagnosis, and management of pyomyositis in the tropical and temperate settings.