Acquired torticollis due to primary pyomyositis of the paraspinal muscles in an 11-year-old boy

Abstract

Torticollis is characterised by tilting and rotation of the cervical spine in opposite directions. Causes can be congenital or acquired. Primary pyomyositis is a rare subacute deep bacterial infection of skeletal muscles that typically affects individuals under 20 years of age from tropical countries. Infrequently, pyomyositis occurs in individuals from temperate regions, usually in immunocompromised adults, and this is defined as secondary pyomyositis. We report a case of acquired torticollis due to primary pyomyositis of the paraspinal muscles in a previously healthy boy from the UK. A prolonged course of antibiotics and physiotherapy led to a complete resolution of his illness. We review how to differentiate pyomyositis from focal myositis, a more common inflammatory muscular cause of acquired torticollis.

Demographic and Clinical Characteristics of Pediatric Patients with the Diagnosis of Torticollis: A Tertiary Clinic Approach

“…8 Determination of underlying causes is valuable in terms of providing treatment for etiology. 12,13 Surgery is still an important treatment option in patients with CMT accompanied by late onset of the treatment and facial asymmetries. 3 Different musculoskeletal pathologies such as craniofacial asymmetry, DHD, metatarsus adductus, clubfoot, C1-C2 subluxation and brachial plexus palsy can be observed simultaneously in children with CMT.…”

“…It is beneficial to add a suitable exercise program to the treatment of primary etiological factor in patients with AT. [12][13][14] Limited number of studies about sociodemographic and clinical characteristics of the patients with torticollis have been observed in the literature. The aim of this study was to give an overview of the differential diagnosis of torticollis in children and to provide insight into our diagnostic and therapeutic algorithm.…”

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

“…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][2][3][4][5][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.…”