Non-Tropical Pyomyositis Caused by Methicillin-Resistant Staphylococcus aureus: An Unusual Cause of Bilateral Leg Pain

Bilateral thigh pyomyositis in an otherwise healthy middle-aged woman: A case report

BACKGROUND

Pyomyositis generally occurs in otherwise healthy young men. Because this condition is unusual among otherwise healthy women in temperate climates, we present the following case.

CASE SUMMARY

An otherwise healthy 43-year-old woman presented with bilateral pain in her lower extremities and fever. Magnetic resonance imaging (MRI) findings were indicative of myositis with a possible abscess. We initiated empirical antibiotic therapy with ceftriaxone. However, the swelling and pain in her legs persisted even after 7 d of treatment. Contrast MRI revealed multiple pockets of pus in the vastus lateralis and gluteal muscles. We performed needle aspiration of these abscesses with ultrasound guidance and local anesthesia. Upon culturing, the purulent material was positive for Staphylococcus aureus. We diagnosed her with S. aureus-induced pyomyositis of the vastus lateralis muscle and gluteus region. Based on the antibiotic sensitivity report, ceftriaxone was administered for an additional 7 d. By day 15 post-drainage, the patient was able to start walking. Oral antibiotic therapy was continued for 1 wk following her discharge from hospital, after which her symptoms resolved completely.

CONCLUSION

Pyomyositis may present with muscle pain, swelling, and fever. Ultrasound-guided percutaneous puncture and drainage may enable timely diagnosis and treatment.

Community-acquired MRSA pyomyositis: case report and review of the literature

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal.

Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic

Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.