Pyomyosite tuberculeuse primitive chez une patiente immunocompétente: à propos d’un cas

Abstract

L'atteinte du muscle strié au cours de la tuberculose chez un sujet immunodéprimé ou à partir de l'extension d'un foyer ostéo-articulaire de voisinage est rare mais bien connue. Toutefois, l'atteinte primitive est exceptionnelle ainsi que celle chez un sujet immunocompétent. L'imagerie par résonnance magnétique (IRM) est d'un grand apport pour le diagnostic avec une excellente sensibilité. Nous rapportons un cas de pyomyosite tuberculeuse primitive du mollet chez une patiente non immunodéprimé tout en précisant l'apport de l'IRM.

Multifocal Subcutaneous and Muscular Tuberculosis in a Young Immunocompetent Man: A Case Report and Literature Review

“…The neck massage and the left leg trauma possibly favored preexisting muscle collections to extend towards the overlying subcutaneous tissue. A similar phenomenon was described by Elshafie et al 2 A number of cases of tuberculous pyomyositis have been reported in the literature, not only in immunocompromised hosts, 4,[11][12][13] but also in patients with no identifiable underlying risk factors, both adults [1][2][3][4]6,9,10,14 and children. 15 In all cases, symptoms related to muscle involvement were the chief complaint, but in some primary pyomyositis could not be assumed because involvement of other structures was detected or strongly suspected.…”

“…5 Systemic immunosuppression (HIV infection, immunosuppressive therapies, chronic renal disease), collagen-vascular diseases or focal muscle frailty (past surgery or trauma, ischemia, foreign bodies) might represent underlying risk factors for tuberculous pyomyositis. 2,9,10 Nevertheless, soft tissue involvement without a clinically and/or radiologically apparent primary focus is extremely rare, particularly in immunocompetent patients. In our patient, multifocal muscle seeding likely resulted from hematogenous spread from an undetected healed focus.…”

“…Magnetic resonance imaging (MRI), with its superb contrast of soft tissue, is reported to be the imaging method of choice for defining the extent of the lesion and accessing the adjacent bones and joints. 5,9,14 However, it has no diagnostic specificity regarding etiology, and collecting samples for microbiologic and/or histologic examination is recommended. 5 Ziehl-Neelsen staining of pus or lesional biopsy may be negative because extrapulmonary specimens have few bacilli.…”