Acquired Torticollis Due to Primary Pyomyositis of the Paraspinal Muscles in an 11-Year Old Boy

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

“…History of antecedent trauma to the affected muscle group ranges from 20% to 50% of cases in previous studies. 1–6 In the study, antecedent trauma was present in 78% of cases; this increases to 89% if manipulation is included as a form of trauma. The pathogenesis of pyomyositis remains unclear, however is widely accepted to be hematogenous in origin.…”

“…4 Most of the pyomyositis case reports encountered on literature review also reveal the same trend of young male patients. 6,9,11,13,16,17…”

“…Most patients with tropical pyomyositis are children or young adults who are otherwise healthy without underlying comorbidities, while most patients in temperate regions are adults and elderly who are immunocompromised or have other serious underlying conditions. 3,5,6 The definite pathophysiology is still unknown but is widely accepted to be hematogenous in origin. An association between transient bacteremia in the setting of skeletal muscle injury has been reported.…”

“…Local trauma has been suggested as a risk factor in developing primary pyomyositis with 20%–50% of cases reporting a history of antecedent trauma to the affected muscle group. 1–6 Pyomyositis commonly involves the proximal, large muscles of the lower limb, i.e., quadriceps, glutei, iliopsoas, and gastrocnemius. 1,2,4,5,7 Previous authors have outlined three stages of pyomyositis: invasive, suppurative, and late.…”

“…9,11,12 Specifically for pyomyositis, MRI is the imaging gold standard. 2,6,7,13,14 Other studies further specify the advantage of MRI in determining pyomyositis in specific regions of the body such as the lumbar region and pelvis, 11,15 hip, 16 and spine. 17 Magnetic resonance imaging is considered an advanced imaging tool and is the investigation of choice in developed countries.…”