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We describe a patient with Crohn's disease and pyomyositis due to Streptococcus anginosus ("milleri"). Early recognition of pyomyositis during its presuppurative phase allowed for prompt antibiotic treatment and rapid resolution of the muscle infection without surgical drainage.
Seventy-two cases of pyomyositis are reported from the north-western highlands of Ethiopia. The majority (76.4%) came from highland areas over 1,800 meters above sea level. The clinical picture of the disease was similar to that seen in other East African countries. Staphylococcus aureus was recovered from 69 of 72 pus cultures. Spontaneous rupture of abscesses was seen in two cases. Four of the five deaths were assumed to be due to complications of the pyomyositis. Further search into non-altitudinal factors is implicated to get a better insight into the nature of the disorder.
A comparative and retrospective trial of 40 patients with tropical pyomyositis covering studies done between January 1, 1987 and November 31, 1990, at the General Hospital at Cosamaloapan, Veracruz, IMSS, was undertaken. The objectives were to compare predisposing factors, clinical data, morbidity, mortaity and hospital stay among 1) medical (group I) and surgical treatment (II), 2) adult and pediatric populations and 3) the clinical stage of the disease (invasive, suppurative and late). In group I, the family history of diabetes (56%), fever (66%) and hospital stay (6.5 +/- 1.8 days) were significantly different from group II (19%, 100% and 12.8 +/- 5.5 days), respectively. The mean age in adult and pediatric populations was 38 and 8 years, respectively. Pediatric patients had lowest hemoglobin levels (9.7 +/- 1.3). Upper respiratory antecedent was highest in suppurative stage (65%). In the late stage eosinophilia (5.9 +/- 6.9), fluctuance muscles (100%), complication rate of 57%, surgical drainage (100%) and mortality of 29% were found. Cultures were performed in 20 cases with negative results in 55% and the remaining 45% were positive to Staphylococcus aureus. Pyomyositis appears to be multifactorial in origin, the antecedents of trauma and upper respiratory infection were the major predisposing factors. Septicemia caused high morbidity and mortality in the late stage. Surgical treatment was frequently needed, increasing costs.
In the past, most cases of pyomyositis occurred among persons living in tropical climates, with the most common pathogen being Staphylococcus aureus. Increased numbers of cases have been reported more recently in North America, particularly in immunocompromised persons, such as those infected with the human immunodeficiency virus (HIV) and those with diabetes mellitus. These patients present with a wider variety of pathogens, including gram-negative bacteria, Streptococcus groups B, C and G, and Mycobacterium avium. Therefore, it seems prudent to consider pyomyositis in the differential diagnosis of persons with HIV infection, diabetes mellitus or other immunocompromising conditions, who present with persistent or worsening muscle aches and pains. Antibiotic treatment with a pencillinase-resistant penicillin is recommended for up to six weeks.
Nontropical pyomyositis in persons with acquired immunodeficiency syndrome (AIDS) is an unusual entity with only a few cases having been described in the United States. Staphylococcus aureus is the most common organism implicated. The infection usually presents in a subacute indolent fashion with minimal inflammation. Fever and leukocytosis may be absent, and blood cultures are frequently negative. The diagnosis usually can be established by a combination of clinical features, computed tomography or ultrasound, and prompt examination of material obtained by aspiration or debridement. This article describes two cases of S aureus pyomyositis in patients with AIDS and reviews the literature relevant to this infection.
Pyomyositis, purportedly a common tropical infection affecting mainly healthy adults and children, appears to be most uncommon in this region. We report a case of pyomyositis caused by a Methicillin-resistant Staphylococcus aureus (MRSA) in a previously healthy army officer. This case serves to illustrate the difficulty in recognising this disease entity, which is why many cases may have been missed. With the increasing incidence of MRSA nosocomial infections, the emergence of MRSA in a hitherto community-acquired infection poses a major concern especially since intravenous drug abuse and acquired immune deficiency syndrome (AIDS) are on the rise in our country. We hope to inculcate greater awareness of this infection.
Pyomyositis is a pyogenic infection of skeletal muscle. It is relatively rare in temperate climates. Unfamiliarity with the lesion may lead to a delay in diagnosis. This report describes pyomyositis of the calf muscles in a patient with chronic hepatitis whose clinical symptoms simulated those of distal deep venous thrombosis. The correct diagnosis was not made until computed tomography revealed a local abscess in the calf muscles.
Pyomyositis, a pyogenic infection of skeletal muscle, is rarely reported in temperate climates. A case of pyomyositis within the paraspinal muscles of a 63-year-old man is reported, with details of diagnostic evaluation and medical and surgical treatment of the condition. Failure to recognize this clinical entity can lead to diagnostic delay and inappropriate management.
Tropical pyomyositis is an infection of large muscle groups that can lead to sepsis and death. The most common etiologic agent is Staphylococcus aureus. It usually occurs in patients living in the tropics but is seen with increasing frequency in temperate climates, particularly in immunosuppressed patients, where it may be misdiagnosed and may cause severe morbidity and mortality. Diagnosis is based on the examination of pus from a muscle aspirate and treatment consists of surgical incision, drainage and appropriate antibiotic therapy. It is stressed to take into account pyomyositis in the differential diagnosis of immunocompromised patients with "cryptic" myalgia.
The pyomyositis is still being a rare disease in our environment. A review of this illness is made as a result of a new case, which shows some peculiarities that differ it from others published previously: the patient showed a basic medullary carcynoma of thyroid with cerebral metastasis and the responsible germ was a Streptococcus pneumoniae. The immunodepressor factors which are presented at most patients who suffer a pyomyositis, the clinic picture so suggestive and the image methods we dispose nowadays, should serve to suspect its diagnostic in an earlier way, proceeding to its bacteriological confirmation before illness evolves to stages as advanced as in the shown case.
Tropical pyomyositis is rarely observed among permanent residents of temperate or cold climates and is, to our knowledge, not described among Norwegians. It is a clinical entity comprising general symptoms of infection and abscesses in skeletal muscles. We present one case of tropical pyomyositis acquired in the Dominican Republic. The patient, a female, had an insidious progression of the disease with fever, chills, and general malaise. On admission she had also developed multiple abscesses affecting muscles of the extremities. She required surgical drainage in addition to antibiotics. Cultures from purulent material revealed Staphylococcus aureus.
A case of pyomyositis, a deep muscle abscess, presenting as a soft tissue sarcoma is reported. Although common in the tropics, this disease is quite rare in the United States. The presentation, diagnosis, and treatment of the problem are discussed and reviewed.
Invasive Acremonium infection in humans is rare. We report a patient with leukemia who developed pyomyositis due to Acremonium species. Painful cutaneous nodules and severe myalgia were the first clinical manifestations during the neutropenic stage after chemotherapy. Magnetic resonance image (MRI) revealed multiple nodular lesions scattered along the intramuscular regions of the lower legs. Culture of an aspiration grew Acremonium species. Surgical drainage was performed. Although all antifungal agents tested showed no in vitro inhibitory activity, we successfully treated this patient with amphotericin B, granulocyte colony-stimulating factor (G-CSF), and surgical drainage.
The iliacus muscle is closely associated with the psoas muscle, femoral nerve, hip joint, pelvic and intraabdominal structures; thus, its disorders may present as lower abdominal pain, hip pain, or femoral neuropathy. Iliacus pyomyositis, a primary bacterial infection of the skeletal muscle not secondary to a contiguous skin, bone, or soft-tissue infection, presenting as hip pain, femoral neuropathy, and sympathetic effusion of the hip joint in an 8-year-old boy mimicked septic arthritis of the hip joint. Computed tomography was helpful in delineating the accurate location of the lesion. Surgical drainage and appropriate antibiotic therapy led to complete resolution and full functional recovery.
A case of non-tropical pyomyositis (PM), in a 63-year-old female patient, affecting gluteus and intrapelvic muscles is presented. Delayed diagnosis and treatment led to long-standing morbidity. Magnetic resonance imaging (MRI) of the pelvis provided valuable information on the nature and extent of the disease and helped to plan surgical management. MRI of the pelvis should be undertaken at an early-stage. Prompt examination of material obtained by aspiration or debridement would then permit an accurate diagnosis and appropriate management.
Four cases of non-tropical pyomyositis in adults are presented and 72 cases reported in the literature are reviewed. The diagnosis is often overlooked or delayed because most physicians are not familiar with the entity. Local signs of inflammation fever, leukocytosis and an elevated erythrocyte sedimentation rate are common features. Staphylococcus aureus is the most common pathogen and the thigh muscles are the most common site involved. Computerized tomography is used to establish the diagnosis and surgical incision and drainage in combination with antibiotic therapy is successful in the majority of the cases.
A case of tropical pyomyositis in a temperate climate is reported and 29 more cases are reviewed from the literature. Because of its rarity and deceiving clinical presentation, the disorder may go unrecognized for weeks in nontropical regions. The role of various imaging modalities in timely and accurate diagnosis and nonsurgical management of this disorder is discussed.
A case is presented of a patient who developed fever, leukocytosis, severe back pain, local overlying spinal tenderness, and left leg weakness on the fifth day postpartum. The patient had epidural anaesthesia for ten hours duration, before and during a forceps delivery. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) of the pelvis and lumbar spine revealed swelling of the left iliacus and piriformis muscles, but no epidural abscess. A diagnosis of isolated piriformis pyomyositis with secondary sciatic nerve irritation was made, and the patient was treated with intravenous antibiotics, non-steroidal anti-inflammatory agents, and morphine analgesia. She made a full, uneventful recovery within 50 days, and was discharged requiring no medications.