Extensive pyomyositis of vastus muscles

From a Machine Saw to a Case of Mycobacterium Fortuitum Pyomyositis

Pyomyositis is a bacterial infection occurring mainly in skeletal muscles. It is most commonly caused by Staphylococcus aureus with initial symptoms including muscle pain, swelling, and site tenderness. When available, the most accurate technique to determine the extent and the specific location of disease is the magnetic resonance imaging. Successful management includes early recognition, timely surgical debridement or drainage, and appropriate antibiotic therapy. This case report describes a case of Mycobacterium fortuitum pyomyositis in an elderly male associated with challenges of successful diagnosis.

The Utility of Musculoskeletal Ultrasonography in Diagnosing Pyomyositis: A Comparison With Surgically and Conservatively Treated Cases

Objective:

The study aimed to determine the accuracy of sonography in diagnosing pyomyositis.

Methods:

A retrospective review of pyomyositis cases in a government hospital between January 1, 2016 and June 30, 2019 was done. All cases underwent a sonogram for the indication of pyomyositis. Positive purulence for surgical cases and improved laboratory parameters for conservative cases were confirmatory for pyomyositis. Comparison with sonographic results using a 2 × 2 contingency table was done to determine sensitivity and specificity.

Results:

A total of 122 cases were included. The sonographic results corresponded with 95% of surgical cases and 89% of conservative cases. A lack of false and true negatives for surgical cases resulted in a sensitivity of 100% (95% confidence interval [CI] = 93%–100%) and a specificity of 0% (95% CI = 0%–71%). In conservative cases, sonography had a sensitivity of 92% (95% CI = 82%–97%) and a specificity of 0% (95% CI = 0%–84%) due to a lack of true negatives.

Conclusion:

Sonography is not limited to primarily as a screening tool but a capable diagnostic imaging choice for pyomyositis, particularly in low-resource settings. The results show the strength of sonography, particularly in the suppurative stage of pyomyositis. [Box: see text]

Treating an intramuscular abscess following toothpick injury in a diabetic patient: A case report and literature review (CARE Complaint)

RATIONALE

Toothpick puncture (TPP) is a penetrating injury that can result in bringing pathogens to the deep space. Such penetrating wounds are typically of pinpoint size with initial symptoms appearing subtle. Consequently, the injury itself is often neglected by patients, or is not detected during physical examinations by medical doctors. Reported complications from such injuries include osteomyelitis and septic arthritis, mostly due to delayed treatment.

PATIENT CONCERNS

A diabetic patient aged 83-year-old presented a 2-day history of skin redness, swelling, and tenderness over his forearm following a TPP a week earlier. Laboratory investigations showed leukocytosis with neutrophilic predominance and a high level of C-reactive protein. Before his operation, cultures of aspirated fluid from the injured site revealed the presence of Streptococcus anginosus, Streptococci viridans, Prevotella intermedia, and Pavimonas (Peptostreptococcus) micra.

DIAGNOSIS

Intramuscular abscess associated with toothpick injury.

INTERVENTIONS

Surgical irrigation with debridement and adjunctive antibiotics of ceftriaxone and clindamycin were given with a satisfactory response. Cultures of debrided tissue showed the presence of P intermedia and P (Peptostreptococcus) micra.

OUTCOMES

A split-thickness skin graft was done. Patient was discharged on the 30th postoperative day.

LESSONS

Toothpick injury, initial symptoms of which are subtle, can in some cases, lead to serious complications especially when managements are delayed. In such situations (including the present case), surgical irrigation and debridement are administrated for the eradication of infections, removal of potentially retained toothpick, and tissue cultures analyzed. Adjunctive antibiotics is recommended to combat both the aerobic and anaerobic microorganisms of the gastrointestinal tract, skin surface, and oral cavity.