Methicillin-resistant Staphylococcus aureus Pyomyositis inducing Guillain-Barré Syndrome - A rare and unexpected clinical presentation

Manoj Kumar Sharma ,Babitha Shibu,Harpreet Singh-Dhillon,Shibu Sasidharan,Gurpreet Kaur-Dhillon

doi:10.35839/repis.5.4.967

Abstract

Tropical pyomyositis is characterized by deep suppurative skeletal muscle infection most commonly by Staphylococcal Aureus (S. aureus) with increasing incidence of infection by community acquired methicillin resistant S. aureus(CA-MRSA). The initial clinical presentation is generally non-specific and requires a high index of suspicion. We report the clinical course of a child from subtropical area of North India who developed multiple deep pyogenous collections, complicated with CA-MRSA septicaemia and followed by unusual complications consistent with Guillain-Barré Syndrome.

Highlights

Case PresentationPyomyositis is a purulent infection of skeletal muscles
Staphylococcus aureus (S. aureus) infection is the most common (90%) cause for morbidity. This is increasingly being replaced by community-acquired methicillinresistant S. aureus (CA-MRSA)
We present the clinical course of a female child hailing from a subtropical area of north India who developed multiple deep pyogenous collections, complicated with staphylococcal septicaemia, followed by an uncommon presentation consistent with Guillain-Barré Syndrome (GBS)

Summary

Introduction

Pyomyositis is a purulent infection of skeletal muscles. Since this was mainly found in tropical countries, it was considered endemic and called “tropical Pyomyositis'. On day 10 of admission, a diffuse swelling in right leg mimicking cellulitis appeared and physical examination revealed tenderness in bilateral thighs. Patient still continued to have fever till day 15 and complained of weakness in both lower limbs. On day 21, patient had only minimal residual weakness in left lower limb with power improved to 4/5 left side (ankle, knee) and full recovery on the right side. She was discharged on day 22 on oral antibiotics (Tab Linezolid 150 mg twice a day) for another 08 days with total duration of antibiotic therapy summing to 04 weeks. Patient remained asymptomatic during follow-up and Neurosurgical consultation for syringomyelia dorsal spine was taken

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Discussion

Conclusion