Primary pyomyositis: an unusual presentation in an older patient with no recognised risk factors

Hadjipavlou, Marios; Butt, David; McAllister, Jack

doi:10.1136/bcr.12.2011.5342

Cited by 12 publications

(14 citation statements)

References 14 publications

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“…CK may not be elevated as one would expect; this lack of CK elevation was seen in our patient 13. Furthermore, the microbiological diagnosis of pyomyositis can be difficult without biopsy as bacteraemia is present in only about 25–35% of patients 2…”

Section: Discussionmentioning

confidence: 50%

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MSSA brain abscess and pyomyositis presenting as brain tumour and DVT

et al. 2013

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A 66-year-old man with a recent radiographic diagnosis of a parietal brain tumour presented with severe left thigh pain that prevented ambulation. On examination, his left anterior thigh was mildly swollen without erythema. Initial concern was for deep vein thrombosis in the setting of brain malignancy or necrotising soft tissue infection. Subsequent imaging and biopsies revealed methicillin sensitiveStaphylococcus aureus(MSSA) pyomyositis of the left thigh and MSSA brain abscess.

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Section: Discussionmentioning

confidence: 50%

“…Risk factors for pyomyositis include trauma, poor nutrition, immunosuppression, HIV infection, diabetes, malignancy, rheumatological disease and cirrhosis 1 2 13. In temperate conditions the most salient risk factors appear to be HIV infection, malignancy, diabetes and steroid use 1 2 14 15.…”

Section: Discussionmentioning

confidence: 99%

MSSA brain abscess and pyomyositis presenting as brain tumour and DVT

et al. 2013

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“…Interestingly, low incidence of previous muscle trauma (0 to 23%) had already been reported in other series of bacterial myositis. 18,19 In this regard, an important clinical consideration is that all patients in our series presented relevant comorbidity and more than half of them suffered from at least two important extra-muscular diseases. Definite immunodeficiency status was registered in three patients; on the other hand, many of the observed chronic co-morbidities may rather be associated with various degrees of immunodeficiency.…”

Section: Discussionmentioning

confidence: 90%

Adult bacterial myositis: report of a single-center series of 26 cases

Gallucci

Ronga

Pietto³

et al. 2016

Ital J Med

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Bacterial infections involving muscle are quite uncommon and generally require specific predisposing factors. Bacterial myositis is more rarely described in the typical kind of patients observed in Internal Medicine (presence of multiple co-morbidities, partial/limited immune-deficiency, advanced age). Twenty-six patients suffering from bacterial myositis (8 women and 18 men; mean age 58.5 years, range 27-82) observed in a single Internal Medicine Unit were reported. Muscles involved were ileopsoas, thigh, paravertebral, gluteus, calf, forearm and rectus abdomen. Simultaneous presence of arthritis was registered in 17 patients and all patients presented relevant comorbidity. Main cultured bacteria were <em>Staphylococcus aureus, Escherichia coli</em>, other Gram-negative bacteria, <em>Streptococcus spp.</em> Multi-drug-resistance was observed in 14 out 26 (53.8%). Computed tomography, ultrasound and magnetic resonance imaging were utilized for diagnostic purposes. Antibiotic treatment was administered to all patients. Surgical debridement and drainage were performed in 12 patients; 7 patients were treated with percutaneous aspiration and drainage. At discharge, relevant functional impairment was present in 17 patients (65.3%). Four patients died (in-hospital mortality 7.6%, global mortality at three months 15.3%). Management of bacterial myositis is difficult and its prognosis is poor. In the near future, this demanding infection will be more frequently observed in Internal Medicine setting as comorbidity, which is very often the main characteristic of these patients.

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“…Pyomyositis is an acute bacterial infection occurring in skeletal muscle with no obvious source that can lead to abscess formation . It is mainly found in tropical climates but is also found in temperate climates in patients who are immunocompromised – HIV, drug abuse, diabetes and trauma being the main predisposing factors . Diabetes is an important contributing factor to pyomyositis by predisposing the skeletal muscle to damage and increasing susceptibility to infections .…”

Section: Discussionmentioning

confidence: 99%

Think pyomyositis!

et al. 2017

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Uncontrolled diabetes is associated with increased risk of infections. An uncommon but rather serious infection is pyomyositis which is a purulent infection of the skeletal muscle. Delay in recognition and diagnosis can lead to serious complications. We report the case of a 44‐year‐old male patient with a background of uncontrolled diabetes who presented with bilateral thigh pain and progressive leg weakness over three weeks. He had no other comorbidities and he denied any recent trauma or foreign travel. On examination he had multiple hard lumps in both thighs and blood results showed leucocytosis and raised inflammatory markers. Magnetic resonance imaging (MRI) showed multiple bilateral thigh abscesses. The diagnosis of pyomyositis was made and drains were inserted into the two largest abscesses. Simultaneously, he was started on antibiotics based on the drained fluid culture and sensitivity. On drainage of the abscesses and completion of eight weeks of antibiotics, he gradually regained the lower limbs' power and the thigh pain resolved. His recovery was aided by the better control of diabetes with insulin therapy. Pyomyositis is mainly encountered in tropical areas. Non‐tropical pyomyositis is more common in immunocompromised patients and patients with uncontrolled diabetes. It requires a high index of suspicion because of its indolent presentation that may mimic other pathologies like cellulitis, diabetic amyotrophy, septic arthritis and deep vein thrombosis. MRI is the best diagnostic tool to differentiate pyomyositis from these disorders. Early diagnosis and intervention with drainage of the abscesses and appropriate antibiotics prevent serious complications and improve the outcome. Copyright © 2017 John Wiley & Sons.

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Primary pyomyositis: an unusual presentation in an older patient with no recognised risk factors

Cited by 12 publications

References 14 publications

MSSA brain abscess and pyomyositis presenting as brain tumour and DVT

MSSA brain abscess and pyomyositis presenting as brain tumour and DVT

Adult bacterial myositis: report of a single-center series of 26 cases

Think pyomyositis!

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