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

Pseudomonas aeruginosa Pyomyositis in a Child With Acute Lymphoblastic Leukemia: A Case Report and Review of Literature

“…A total of 14 cases of pyomyositis in children affected by hematological malignancy were reported (Table 1). In most cases, local muscular pain was the main reported symptom (11/14), [7][8][9][10][11][12][13][14][15] whereas fever was not always present. A minority of patients presented a tense palpable mass or multiple nodular lesions (3/14) 10,11,16 ; redness and skin warmth in the area were reported only in 2 cases.…”

“…14 In most cases (9/14), MRI was performed as the first radiologic examination to detect the muscular infection. 8,[11][12][13][14][15][16][17] When ultrasound was chosen as the first radiologic examination (2/14), it resulted diagnostic, showing an abscess, 7,10 yet it is unclear if it would have been similarly diagnostic in the earlier, nonsuppurative phases of the infection. Evolution in muscular abscess occurred in most patients (10/14) during the course of infection, despite intravenous antibiotic therapy, and was followed by drainage.…”

“…Notably, pyomyositis was the first presentation sign of hematological malignancy in 2 patients: 1 was subsequently diagnosed having ALL,13 and the other chronic myeloid leukemia 14. In most cases (9/14), MRI was performed as the first radiologic examination to detect the muscular infection 8,11–17. When ultrasound was chosen as the first radiologic examination (2/14), it resulted diagnostic, showing an abscess,7,10 yet it is unclear if it would have been similarly diagnostic in the earlier, nonsuppurative phases of the infection.…”