Abstract
We present the case of a 60-year-old diabetic who had acute-onset shortness of breath that was preceded by bilateral thigh and hip pain. He was initially admitted for septic arthritis with community-acquired pneumonia. His respiratory complaints resolved, but he continued to have thigh pain. Ultrasound of the lower limbs showed thrombosis of the deep veins of the thigh and MRI showed a collection in the right thigh suggestive of pyomyositis with thrombosis in deep veins abutting the collection. Contrast enhanced CT (CECT) chest showed multiple peripherally located pneumatoceles and cavities in both the lungs suggestive of septic emboli. Here, we present a case of pyomyositis of thigh muscles causing Deep vein thrombosis (DVT) and septic pulmonary emboli (reverse Lemierre’s syndrome).
Highlights
Primary pyomyositis or spontaneous bacterial myositis is characterized by suppuration of single or multiple skeletal muscles [1,2]
As it is mostly encountered in the tropics, terms such as tropical pyomyositis (TP) or myositis tropicans are in use, but this entity is no longer confined only to tropics
The patient improved symptomatically over the course of his hospital stay and was able to walk without support within the sixth day of starting linezolid and was discharged later. So what made this case so unique? The simultaneous occurrence of separate septic processes of pneumonia and pyomyositis along with deep venous thrombosis led us to reconsider an alternate etiology that could be explained by a single cause
Summary
Primary pyomyositis or spontaneous bacterial myositis is characterized by suppuration of single or multiple skeletal muscles [1,2]. After 4 days of onset of pain, he developed high-grade fever with cough and shortness of breath He went to a local hospital and initial investigations showed an elevated total leukocyte count with neutrophilia and high blood sugar with positive urine ketones. Blood and urine cultures that were sent on day 1 were sterile He became afebrile and his respiratory symptoms as well as DKA and AKI resolved, but he continued to have pain in the right thigh. CECT chest was performed on day 4 of admission, which showed multiple small thin-walled cavities and pneumatoceles in bilateral lung fields suggestive of partially treated septic emboli, likely to be because of Staphylococcus aureus infection arising from septic embolization from the thighs. The patient improved symptomatically over the course of his hospital stay and was able to walk without support within the sixth day of starting linezolid and was discharged later
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