Serratia Myositis in an Intravenous Drug User

Abstract

Serratia marcescens is a well-known causative agent of hospital-acquired infections, especially in the intensive care unit (ICU), but can also cause community-acquired infections. Infectious myositis due to Serratia is an extremely rare infection. We present a rare case of myositis due to Serratia marcescens in an intravenous drug user. To the best of our knowledge this is the first case of Serratia marcescens infectious myositis in an intravenous drug user. Our report not only reminds us that Serratia marcescens could be a pathogen in the community, but also highlights the fact that drug users are a special population with rare and unusual infections and as a result the clinician must have a high clinical suspicion and vigilance in order to diagnose and treat them. I N t r O D U c t I O N Serratia spp, particularly Serratia marcescens, have been recognized as a cause of a wide variety of hospital-acquired infections, especially in the intensive care unit (ICU). However, various studies have shown that a considerable percentage of Serratia spp infections are also community-acquired. Respiratory, urinary tract infections and keratitis/endophtalmitis are the most common, with meningitis, bacteremia, endocarditis, peritonitis, osteomyelitis and skin infections being occasionally reported. Myositis due to Serratia is an extremely rare infection. To the best of our knowledge, only two documented cases of infectious myositis due to Serratia marcescens have been described in the literature. We present a case of myositis due to Serratia marcescens in an intravenous drug user. c A s E P r E s E N t A t I O N A 38-year-old man presented to the emergency department with a 1-week history of pain in the left flank and thigh and fever with rigor during the preceding three days. There was no history of trauma, intense physical exercise or recent admission to a hospital. Five years earlier, hepatitis C had been diagnosed and the patient was an intravenous drug user of illicit drugs. On examination, the patient was alert and oriented and appeared distressed. The temperature was 38C, the blood pressure 110/70 mm Hg and the pulse rate 100 beats cAsE rEPOrt Department of Internal Medicine, General Hospital of Ierapetra, Crete, Greece Second Department of Internal Medicine, General Hospital of Volos, Volos, Greece HOSPITAL CHRONICLES 2014, 9(3): 199–201 Correspondence to: Christodoulos Dolapsakis, MD, 54 Ithakis Street, 11 251 Kato Patissia, Athens, Greece; Tel.: +30 6979835229; e-mail: dolapsak@yahoo.gr Manuscript received October 4, 2013; Revised manuscript received February 16, 2014; Accepted March 21, 2014 KEy wOrDs: Serratia; fever; myositis; pyomyositis; intravenous drug user AbbreviAtions ICU = intensive care unit ECDC = European Center for Disease Prevention and Control HIV = human immunodeficiency virus qd = quaque die (once daily) bid = bis in die (twice daily) tid = ter in die (three times daily) Conflict of Interest: none declared