Pyomyositis of the piriformis muscle presenting with sciatica in a teenage rugby player

Giebaly, Dia Eldean; Horriat, Sam; Sinha, Aabha; Mangaleshkar, Singu

doi:10.1136/bcr.12.2011.5392

Cited by 16 publications

(15 citation statements)

References 15 publications

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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%

“…The majority of pyomyositis occurring in temperate climates is due to S. aureus but Group A Streptococcus, Pneumococcus, Pseudomonas, Neisseria, Haemophilus and Escherichia coli may be a potential but less common responsible cause . The most commonly affected muscle groups are that of the thigh but other less commonly affected parts of the body are back, buttock, arm and chest wall …”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Think pyomyositis!

et al. 2017

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“…3 A previous case series briefly listed torticollis as a symptom in a child with pyomyositis of the levator scapulae,6 but we believe ours is the first detailed report of pyomyositis primarily presenting as torticollis. Pyomyositis often affects the largest muscle groups, most commonly around the pelvic girdle 10. The clinical picture often begins with a painful muscle that is tense on examination but initially presents minimal erythaema.…”

Section: Discussionmentioning

confidence: 99%

“…The mainstay of treatment for myositis is steroids, while for pyomyositis a prolonged course of intravenous antibiotics and sometimes surgical drainage can be required. Identifying the differentiating features between these two pathologies will help clinicians to make an earlier diagnosis of pyomyositis, prior to the formation of abscesses 10 11…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…In addition, previous case reports have described an association between piriformis pyomyositis and sciatic nerve irritation. [12357] In this case, however, the SEA resulted from direct extension of an abscess from the pyriformis muscle into the spinal canal via a sacral foramen abscess [Figure 3]. [12]…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural abscess in a patient with piriformis pyomyositis

Abou‐Al‐Shaar

Arnone

et al. 2016

Surg Neurol Int

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Background:Spinal epidural abscess resulting from piriformis pyomyositis is extremely rare. Such condition can result in serious morbidity and mortality if not addressed in a timely manner.Case Description:The authors describe the case of a 19-year-old male presenting with a 2-week history of fever, low back pain, and nuchal rigidity. When found to have radiographic evidence of a right piriformis pyomyositis, he was transferred to our institution for further evaluation. Because he demonstrated rapid deterioration, cervical, thoracic, and lumbar magnetic resonance imaging scans were emergently performed. They revealed an extensive posterior spinal epidural abscess causing symptomatic spinal cord compression extending from C2 to the sacrum. He underwent emergent decompression and abscess evacuation through a dorsal midline approach. Postoperatively, he markedly improved. Upon discharge, the patient regained 5/5 strength in both upper and lower extremities. Cultures from the epidural abscess grew methicillin-sensitive Staphylococcus aureus warranting a 6-week course of intravenous nafcillin.Conclusion:A 19-year-old male presented with a holospinal epidural abscess (C2 to sacrum) originating from piriformis pyomyositis. The multilevel cord abscess was emergently decompressed, leading to a marked restoration of neurological function.

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Pyomyositis of the piriformis muscle presenting with sciatica in a teenage rugby player

Cited by 16 publications

References 15 publications

Think pyomyositis!

Think pyomyositis!

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

Spinal epidural abscess in a patient with piriformis pyomyositis

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