Visual Diagnosis: 11-Year-Old Boy With Leukemia, Fever, Elbow, and Leg Pain

Abstract

The diagnosis of pyomyositis requires a high index of suspicion in patients with hematologic malignant neoplasms. Correct diagnosis might be delayed initially because of vague clinical presentation, overlapping symptoms, and nonspecific clinical signs. Pyomyositis should be included in the differential diagnosis when a patient develops swollen or tender muscles after chemotherapy with or without bacteremia. Prompt treatment with broad-spectrum antibiotics that cover S aureus and resistant emerging gram-negative organisms, specifically E coli, should be initiated immediately in patients with hematologic illnesses along with close monitoring and follow-up.

Primary pyomyositis of the forearm in a non-immunocompromised boy

“…are additional pathogens [10] . Mycobacterium tuberculosis, Mycobacterium avium complex, Neisseria gonorrhoeae, Bacteroides fragilis, Fusobacterium spp., and fungi have rarely been identified as causative pathogens in a few cases of PM, mostly in immunocompromised patients, mainly those with hematologic malignancies [15,16] . The distribution of MSSA and methicillin-resistant S. aureus (MRSA) cases varies according to the individual patient susceptibility and geographic location [17] .…”

“…Even though diagnostic delays are frequent in PM, early diagnosis and treatment are crucial to avoid morbidity and mortality from sepsis. Empirical antibiotics alone without open or percutaneous drainage can cure some cases of stage one disease [7,16,22] . In these cases, it is prudent to administer a broad-spectrum antibiotic that covers both S. Aureus and Gram-negative organisms, especially in immunocompromised individuals [16] .…”

“…Empirical antibiotics alone without open or percutaneous drainage can cure some cases of stage one disease [7,16,22] . In these cases, it is prudent to administer a broad-spectrum antibiotic that covers both S. Aureus and Gram-negative organisms, especially in immunocompromised individuals [16] . When the pathogen is identified by culture, antibiotic treatment should be adjusted accordingly, like in our case.…”

“…When the pathogen is identified by culture, antibiotic treatment should be adjusted accordingly, like in our case. The optimal duration of treatment depends on the patient's immune status, the number of abscesses, the surgical intervention, and importantly, the clinical course [16] . The duration of antibiotic therapy should likely be no less than two to three weeks, while the timing of switch from intravenous to oral antibiotic treatment is based on clinical and laboratory improvement [23] .…”