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Group A beta-hemolytic Streptococcus pyomyositis continues to be an uncommon disease. We present a case of a 7-year-old boy with an M protein type 1, streptococcal pyrogenic exotoxin A and B, Streptococcus pyogenes pyomyositis and streptococcal toxic shock syndrome.
Spontaneous pyomyositis, or so-called tropical pyomyositis, developed in the hamstring muscles of a 62-year-old man with rheumatoid arthritis and Felty's syndrome. The diagnosis was confirmed by computerized tomography, and the appropriate muscle compartment was surgically drained.
Pyomyositis is a common disease in the tropics that is reported with increasing frequency in the United States. We describe an unusually fulminant, fatal case in a previously healthy adolescent male. This case illustrates the clinical progression of pyomyositis from localized muscle infection to disseminated disease, and highlights the importance of considering this rare diagnosis in any stage of occult sepsis.
Pyomyositis is a bacterial infection with abscess formation affecting large skeletal muscles. It is predominantly caused by Staphylococcus aureus. The disease is common in tropical areas, but rare in temperate climates. We report a patient with multiple myeloma who developed a giant elastic tumor on the right thigh and a hen egg-sized tumor on the right upper arm. MR imaging revealed cystic spaces in the femoral quadriceps and brachial biceps muscles. A large amount of pus with foul smell was removed by incision, drainage and aspiration of the two tumors. The lesions were successfully treated with intravenous administration of antibiotics. Repeated bacterial cultures yielded only Bacteroids fragilis. To our knowledge, this is the first report of pyomyositis due to Bacteroides fragilis.
A patient with iliopsoas muscle pyomyositis was successfully treated with intravenous antibiotics alone. The diagnosis was made by ultrasonography and X-ray computed tomography after five days of spiking fevers. Ultrasonography and X-ray computed tomography revealed swelling of the muscle body but no abscess formation. We emphasize the usefulness of early diagnostic imaging to allow conservative treatment of iliopsoas muscle pyomyositis.
We report on a 12-year-old boy who suffered from staphylococcal pyomyositis in both arms following vigorous exercise. No trauma or skin lesions were observed. In non-tropical areas, the etiology of pyomyositis can be related to muscle injury caused merely by exercise, without any other predisposing factors.
A 45-year-old man visited the first hospital complained of high fever on January 2003. He was diagnosed as having Influenza virus type A infection and prescribed of Oseltamivir. He was afebrile next day, but severe myalgia of neck, shoulder, lumbar region and right femoral region was appeared. His illness was considered as polymyalgia rheumatica and started of oral steroid therapy. His symptom was deteriorated and transferred to our hospital. Echography, Ga scintigraphy, computed tomography and magnetic resonance imaging revealed the multiple abscesses and the diagnosis of pyomyositis was made. Pyomyositis following Influenza virus infection must be considered as a differential diagnosis of myalgia after Influenza virus infection.
Pyomyositis occurred in a man who had not been to the tropics. The condition is common in the tropics but most unusual in temperate climates and is nearly always caused by Staphylococcus aureus. Pyomyositis must be borne in mind in obscure cases of sepsis, as early recognition and treatment are essential to prevent a fatal outcome.
A young male with a previous splenectomy presented with Streptococcus pneumoniae meningitis complicated by pyomyositis. Pneumococcal meningitis in asplenic patients is well recognized, but the association of pyomyositis as a complication has not to our knowledge been previously reported.
Two children, aged 6 and 8 years, were admitted to the hospital because of fever, pain, and tenderness over the muscular masses of the thigh and calf, respectively. The presumptive diagnosis of pyomyositis was confirmed by ultrasound studies. Antibiotic treatment was administered in both cases while one child also required surgical drainage of the muscular suppuration. Complete recovery was achieved in both cases. Performance of ultrasound studies is indicated whenever pyomyositis is suspected.
Pyomyositis (PM) is an uncommon cause of acute bacterial infection occurring in skeletal muscle. This disease is rare in non-tropical areas, and PM caused by Mycobacterium is very rare in a non-immunocompromised person. The presence of temporal area swelling may lead to a differential diagnosis toward more common pathologies, such as a complication of mastoiditis or a neoplasm of the temporal area. This article describes a case of tuberculous pyomyositis in a non-immunocompromised woman, the diagnosis of which was confirmed by sonographically guided fine-needle aspiration.
Tropical pyomyositis is a primary infection of the skeletal muscles, that occurs mainly in tropical countries. At onset its manifestation is nonspecific, thereby hindering the diagnostic. The natural history of this disease is commonly benign, with rare complications. This presentation describes four cases of pyomyositis with peculiar manifestations and complications.
Two cases of pyogenic infection of skeletal muscle presented in a fashion that initially suggested a diagnosis of septic arthritis. One infection was caused by Staphylococcus aureus, but the other was caused by Streptococcus pyogenes, which is rarely implicated in pyomyositis. We note that the number of reported cases of pyomyositis in temperate climates has increased in recent years.
A case of nontropical pyomyositis is reported in a young male without predisposing factors. The disease was preceded by a tonsillitis, and the presentation initially suggested a septic arthritis of the shoulder. Fusobacterium, a highly unusual pathogen in pyomyositis, was isolated from an abscess in the infraspinatus muscle. The increasing frequency of the disease in areas with a temperate climate and the pathogenesis are discussed. Our case had the classic features of Lemierre's syndrome: invasion of the bloodstream by Fusobacterium species from a tonsillitis.
During a 2-month period, 17 cases of pyomyositis were seen in the hospital population of a large refugee camp for Cambodians in Thailand. The temporal clustering of the cases suggests an epidemic pattern. Patients in this series were generally young and otherwise healthy. All had gram-positive cocci demonstrated in abscess pus, and all responded to surgical drainage. Fourteen (82%) of the cases were initially misdiagnosed by volunteer physicians who were unfamiliar with the disease. The authors suggest that a mosquito-borne virus predisposes to the development of the pyomyositis abscess.
Serum immunoglobulin (IgG, IgM, IgA) and complement (C3, C4) levels were measured by radial immunodiffusion technique in a group of 16 Nigerian patients with tropical pyomyositis (TP). Sixteen healthy Nigerians, age- and sex-matched with the patients, were also included in the study as control subjects (CS). A significantly low level of circulating IgM (P less than 0.01) and elevation of the serum levels of IgG (P less than 0.01) and IgA (P less than 0.01) were observed in TP compared to CS. Mean serum complement (C3, C4) levels were found to be similar in patients and controls. Microbiological culture tests showed that 14 pus specimens (88%) and 3 blood specimens (19%) from the patients were positive for Staphylococcus aureus. It was therefore proposed that IgM antibody deficiency (primary or acquired) against S. aureus may be the cause of tropical pyomyositis in Nigerians.
We report three patients with pyomyositis due to Staphylococcus aureus. Magnetic resonance imaging aided in the accurate diagnosis of the infection and of the extent of involvement. Incision, drainage and antibiotic therapy eradicated the infection in all the patients. We suggest clinical or subclinical bacteraemic seeding of the diseased muscle, as the most likely mechanism for pyomyositis.
Pyomyositis is a pyogenic infection of skeletal muscle. Its incidence in temperate countries though low is rising. Most cases from the temperate region involve immuno-compromised patients. The onset is usually insidious with progression to large purulent collections. Because of its low incidence in temperate countries, it is often initially misdiagnosed. A high index of suspicion with appropriate imaging techniques, aggressive surgical intervention and adjunctive antibiotic therapy are the keys to prompt resolution. A case of pyomyositis mimicking right iliac fossa (RIF) mass is described with a review of the literature.