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PubMed1995

Obturator internus pyomyositis. A case report.

Pyomyositis appears to be increasing in prevalence in temperate climates, and often the orthopaedist is integral in the decision making and care of these patients. This is the first reported case of spontaneous bacterial pyomyositis involving the obturator internus muscle. Deep pelvic infections involving the psoas, iliacus, piriformis, and obturator internus can be a significant cause of morbidity and mortality. The infection subsequently may exit the pelvis, and conceivably may progress to a septic hip, bursitis, or lower extremity cellulitis. Improvements in noninvasive imaging such as ultrasound, computed tomography, and magnetic resonance imaging have produced finer resolution of tissue planes. Because of the pathology's deep location within the pelvis of the patient described here, all 3 tests were integral in the surgical planning, exposure, and proper diagnosis. Although 95% of pyomyositis cases are caused by Staphylococcus aureus, cases of pyomyositis with negative cultures have been described. Consideration should be made of disseminated Neisseria gonorrhoeae in sexually active individuals, and cultures should include Thayer-Martin agar to decrease the likelihood of a false-negative culture result.

Adolescent↗
PubMed1994

[Neck pyomyositis associated with polymicrobial sepsis of sinusal origin].

Spontaneous pyomyositis (primary pyomyositis) is an infrequent disease in non-tropical countries, caused by bacterial infection of skeletal muscle. Although pyomyositis is associated in many cases to septicemia, the occurrence of that disease as a secondary manifestation of bacteremia is very unusual, requiring a high-grade index of suspicion to diagnose it in the early stages. We present one case of cervical pyomyositis, caused by Fusobacterium necrophorum and group F streptococcus, during the course of a sepsis of sinusal origin, that was treated without surgical therapy. This so uncommon form of presentation of Fusobacterium septicemia, its diagnosis and treatment are discussed.

Adult↗
PubMed1994

Absence of neutropenia in African patients with AIDS and associated pyomyositis.

The association between AIDS and pyomyositis was recently pointed out in temperate and tropical countries. In Western countries, the patients affected by pyomyositis associated with AIDS in most cases are neutropenic. We compare a group of 17 patients with pyomyositis and AIDS living in temperate climates from the literature, and 11 patients affected by the same association seen by us in northern Uganda. The patients from Western countries were significantly more neutropenic and their mean of the neutrophil count was significantly lower when compared with our group. We suggest that the defective neutrophil function associated with HIV infection play a major role in the pathogenesis of pyomyositis in our patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

[A case report of pyomyositis--early diagnosis and follow-up by MRI].

We report a rare case of pyomyositis in a 28-year-old Japanese woman who was not immunocompromised. She was admitted because of high fever, sore throat, and severe tenderness and swelling of the right calf. Redness, swelling, and tenderness indicated presence of acute inflammation in the calf. CT of the lower extremities demonstrated low density areas in the right soleus muscle and surrounding fascia with marked swelling, which were of high signal on T2 weighted images of MRI. There was no finding of abscess formation. A tentative clinical diagnosis of acute pyomyositis was made, and antibiotics therapy with a combination of fosfomycin and sulbactam/cefoperazone was started although the arterial blood culture was negative for bacteria. Associated acute tonsilitis was the most probable focus of pyomyositis. Antibiotics relieved her symptoms, and the inflammation subsided in several weeks. No surgical procedure was necessary. MRI taken tree weeks after the onset demonstrated abscess formation between the soleus and gastrocnemius muscles. Slight high intensity indicating scar formation remained in the area of the former abscess six weeks after the onset. MRI was very useful not only in making the early diagnosis but also in the follow-up of pyomyositis.

Adult↗
PubMed1992

Bacterial pyomyositis in a patient with a multiple myeloma.

Pyomyositis is relatively rare in regions with a temperate climate. The most common aetiologic agent is staphylococcus aureus. Most patients with pyomyositis from temperate regions involve immunocompromised states. Because of the rarity, it is often initially misdiagnosed. Computed tomography scan is considered the most helpful tool for the diagnosis of pyomyositis. We present a case in a patient with multiple myeloma.

Female↗
PubMed2003

Pyomyositis as a focus of infection in hematological disorders: a report of 3 cases.

The cases of 3 patients with pyomyositis associated with hematological disorders are reported. A 40-year-old man in the blastic phase of chronic myelogenous leukemia and 2 men aged 46 and 71 years with neutropenia due to myelodysplastic syndromes all reported high fever and severe local myalgia and had marked elevation of C-reactive protein. Magnetic resonance imaging revealed muscle abscesses or fasciitis, and the findings led to the diagnosis of pyomyositis. Methicillin-resistant Staphylococcus aureus was isolated from the abscesses of 2 patients, and surgical drainage proved more effective than did antimicrobial agents. It should be recognized that pyomyositis is a possible source of infection in patients with hematological disorders.

Adult↗
PubMed2003

Stenotrophomonas maltophilia septicemia with pyomyositis in a chemotherapy-treated patient.

Pyomyositis is a rare complication of chemotherapy. A 35-year-old male patient with myelodysplastic syndrome developed Stenotrophomonas maltophilia bacteremia shortly after chemotherapy, and Stenotrophomonas maltophilia-related pyomyositis was encountered after recovery from neutropenia. He recovered completely after surgical drainage and a protracted course of antibiotic treatment. It is postulated that subclinical myopathy, immunosuppression secondary to the malignancy, or chemotherapeutic drugs may predispose to pyomyositis. Early recognition of this unusual complication in a cancer patient undergoing chemotherapy can prevent further catastrophes.

Adult↗
PubMed2004

Bacterial Pyomyositis.

Bacterial pyomyositis has been defined as a subacute, deep bacterial infection of the soft tissues. The entity was originally described only in tropical climates, but it is increasing in incidence in temperate climates, such as in the United States. This is mainly attributed to the presence of immunocompromising states such as HIV/AIDS or liver disease. The etiology of pyomyositis remains a mystery, but its characteristics are well-described. If untreated, the disease process progresses through three distinct stages. The first stage is defined by vague complaints, muscle pain, and a low-grade fever. The second stage presents as worsening pain, swelling, fever, and actual abscess formation in the muscle. If the patient remains untreated, pyomyositis progresses to the third stage, which includes septicemia and possible septic shock. Large muscles around the pelvis are most commonly affected, and Staphylococcus aureus is the bacteria seen in most documented cases. To make a timely diagnosis and prevent serious sequelae, physical examination, laboratory results, imaging studies, and a high clinical suspicion must all be combined. Magnetic resonance imaging is the diagnostic study of choice, but it may be inconclusive early in the disease process. Definitive diagnosis must be made with aspiration or surgical drainage. Once diagnosed, treatment consists of appropriate intravenous antibiotics and possible surgical intervention. A full recovery is expected if appropriate treatment is initiated early in the process.

Journal Article↗
PubMedDate not supplied

Pyomyositis of the thigh due to Prevotella melaninogenica.

Pyomyositis is an uncommon infection in temperate climates, however, it is being more frequently reported among patients with diabetes or malignancy, or those who are immunocompromised. It is predominantly caused by Staphylococcus aureus, and rarely by Bacteroides species. Pyomyositis due to Prevotella melaninogenica has not previously been reported. We describe an elderly patient with pyomyositis of the thigh due to P. melaninogenica which was successfully treated by surgical incision and drainage in combination with metronidazole therapy.

Aged↗
PubMed1984

Pyomyositis. Increasing recognition in temperate climates.

Pyomyositis is common in the tropics yet is rarely reported in temperate climates. A woman in whom pyomyositis developed in a temperate climate is presented. Computed tomography was the key in the diagnosis of the disease involving the muscles of the left lateral chest wall. The patient's condition responded to intravenous antibiotics and open abscess drainage. The 31 cases reported in the United States are reviewed. Unfamiliarity still poses a barrier to early diagnosis, although pyomyositis is being more frequently described in temperate climates.

Adult↗
PubMed1995

Pyomyositis in an adolescent female athlete.

A case of pyomyositis in a healthy 13-year-old female volleyball player is presented and discussed. This case is unusual because, historically, pyomyositis has been more common in males, especially those who participate in strenuous physical activity. However, competitive sports and vigorous exercise programs are becoming more widely available to young females. Therefore, a relative increase in the number of adolescent women with pyomyositis can be expected.

Abscess↗
PubMed1982

Intracranial suppuration complicating tropical pyomyositis. Report of two cases.

Tropical pyomyositis complicated by intracranial abscesses is described in two Nigerian male patients, aged five and 50 years. In both cases, the lesions were verified at autopsy. The occurrence of brain abscesses in pyomyositis is briefly reviewed. The complication may not be as rare as previously thought and this will appear if port-mortem examination is performed on most, possibly all, fatal cases of pyomyositis.

Brain Abscess↗
PubMedDate not supplied

Tropical pyomyositis in eastern Ecuador.

In the ten year period 1980-1989, 97 patients were treated for tropical pyomyositis at Hospital Vozandes Oriente in eastern Ecuador, accounting for 2.2% of surgical admissions. Operation records from an affiliated hospital in Quito showed that, high on the Andean plateau, pyomyositis accounted for only 0.1% of surgical admissions. Among the patient population of Ecuador's eastern tropical rain forest, persons who were members of an indigenous ethnic group were affected with pyomyositis twice as often as would be expected from their representation in the general population.

Abscess↗
PubMed2004

Bacterial pyomyositis in the United States.

The incidence of reported bacterial pyomyositis is increasing in the United States, especially among immunocompromised persons. This review summarizes all reported cases of pyomyositis among human immunodeficiency virus (HIV)-infected persons worldwide and HIV-negative persons in the United States since 1981. During the era of combination antiretroviral therapy, bacterial pyomyositis among HIV-infected persons typically occurred in those with end-stage acquired immunodeficiency syndrome. Among non-HIV-infected patients, about half have a serious underlying medical problem, most commonly diabetes mellitus, malignancy, or a rheumatologic condition. These patients are more likely to have a gram-negative infection, a normal white blood cell count, multifocal involvement, or higher mortality than those without an underlying medical condition. The characteristics of cases in temperate areas are similar to tropical cases, except that the former occurs more often in immunocompromised persons; this may change with the HIV epidemic in tropical regions.

AIDS Serodiagnosis↗
PubMed2004

Multifocal pyomyositis in an immunocompetent patient.

Pyomyositis is defined as suppurative infection of the skeletal muscle and usually occurs in immunocompromized patients. We managed a 23-year-old man admitted for myalgia and evidence of infection, with onset after a strenuous physical activity. Numerous muscles were involved. Multiple abscesses were visualized by ultrasonography and computed tomography, with predominant involvement of the pelvic muscles. Examination of the aspirate from a forearm abscess recovered Staphylococcus aureus. No factors associated with immunodeficiency were found. Appropriate antimicrobial therapy ensured complete resolution of the infection. Pyomyositis is rare in immunocompetent individuals. Myalgia, fever, and rhabdomyolysis should suggest pyomyositis. Computed tomography and magnetic resonance imaging are the best investigations for confirming the diagnosis.

Abscess↗
PubMed2003

Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report.

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.

Adult↗
PubMedDate not supplied

Gram-negative bacterial pyomyositis: unique case and review.

Bacterial pyomyositis in tropical or temperate climates is usually associated with gram-positive organisms, and Staphylococcus aureus has been recovered most often. In contrast, skeletal muscle infection due to aerobic gram-negative bacteria is an acknowledged rarity, even in tropical areas. A literature review revealed only five organisms implicated in gram-negative pyomyositis in the United States; to this list, we add a unique case of pyomyositis caused by Serratia marcescens that occurred in a patient with multiple myeloma. Although the data are limited, it appears that lower leg muscles are more likely to be involved and that clinical cure is often achieved following appropriate drainage and antibiotic therapy.

Aged↗
PubMedDate not supplied

Pyomyositis in patients with diabetes mellitus.

Pyomyositis is a pyogenic infection of skeletal muscle that is endemic in the tropics and is being recognized with increasing frequency in temperate climates. We report two cases of nonendemic pyomyositis in patients with diabetes mellitus. A review of the literature suggests that diabetes mellitus may be an important risk factor for the development of pyomyositis. Possible mechanisms of this association are discussed.

Adult↗