Tropical pyomyositis of erector spinae complicated with spinal epidural abscess

Zheng, Yun-Cong; Chen, Ching-Chang; Wei, Kuo-Chen; Chen, Jyi-Feng; Lee, Shih‐Tseng; Liao, Cheng-Chih

doi:10.1016/j.clineuro.2014.10.022

Cited by 5 publications

(11 citation statements)

References 17 publications

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“…Cases are often identified late as a result and are frequently associated with progression, developing into communicating spinal epidural abscess complexes as seen in various published case reports. 3–5 Isolated ESPM is considerably rarer, likely due to the product of increased suspicion and vigilance, together with early imaging to aid diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…If diagnosed and treated late, the greater the number spinal segments involved, the greater the likelihood of irreversible myelopathy and radiculopathy even after successful surgical drainage. 4,5 Furthermore, streptococcal myositis is also thought to have high case fatality due to toxin production inducing release of cytokines leading to septic shock and eventual multi-organ failure. 9,10…”

Section: Discussionmentioning

confidence: 99%

“…Because of its rarity, as opposed to PM of larger muscle groups like the gluteal or thigh muscles, and its insidious onset with non-specific symptoms in the early stages, erector spinae PM is often diagnosed late when patients manifest neurological symptoms due to associated spinal epidural abscesses (SEA). 3–5 Current literature supports aggressive surgical intervention in the management of late manifestations of erector spinae PM. 5,6…”

Section: Introductionmentioning

confidence: 99%

“…3–5 Current literature supports aggressive surgical intervention in the management of late manifestations of erector spinae PM. 5,6…”

Section: Introductionmentioning

confidence: 99%

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Uncommon primary Group A streptococcal erector spinae pyomyositis diagnosed as muscle strain in a fit young male

Zheng

Yoong

2019

SAGE Open Medical Case Reports

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Acute lower back pain in a fit healthy male with recent strenuous physical activity is often attributed to muscle strain. We report a rare case of erector spinae pyomyositis developing in a young and otherwise healthy young adult male that was almost misdiagnosed as muscle strain. Despite admission and close monitoring, diagnosis was only confirmed on a magnetic resonance imaging of the spine later during the hospital stay. Early diagnosis in this case allowed successful treatment with intravenous antibiotics alone, without requiring further surgical drainage or development of further neurological sequelae, common in later stages of erector spinae pyomyositis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…3–5 Current literature supports aggressive surgical intervention in the management of late manifestations of erector spinae PM. 5,6…”

Section: Introductionmentioning

confidence: 99%

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Uncommon primary Group A streptococcal erector spinae pyomyositis diagnosed as muscle strain in a fit young male

Zheng

Yoong

2019

SAGE Open Medical Case Reports

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“…Bacterial infection in the erector spinae muscle is not so common. Staphylococcus aureus occasionally causes abscess in the erector spinae muscle, named tropical myositis, which is restricted in the tropical regions [31,32]. However, this disease entity is somewhat different from erector spinae muscle abscess caused by bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with continuous epidural anesthesia for herpes zoster-related pain control: a case report and review of the literature

et al. 2018

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Background: Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients. Case presentation: A 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with continuous epidural anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient. Conclusions: Treatment with sensitive antibiotics and timely open surgical drainage is necessary to cure catheterrelated meningitis and secondary deep muscle abscesses in hemodialysis patients. Our case also suggests that epidural anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus.

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