Tropical Pyomyositis in Immunocompetent Hosts Posing Diagnostic Challenges: A Case Series

Abstract

Abstract Pyomyositis is an acute pyogenic infection of the muscles and tissues which results in localized pus collections and abscess formation. This entity at times becomes difficult to diagnose due to lack of specific signs and atypical or nonspecific manifestations. This condition is a mimic for a wide range of differential diagnoses due to which the patient often receives many unwarranted antibiotics. Furthermore, the deep location of the muscles makes the clinical signs in apparent leading to misdiagnosis as rarer entities such as inflammatory myositis. In the last 1 year, four such interesting cases were admitted in this tertiary care center with different clinical presentations. All these cases were healthy, immunocompetent individuals who presented to smaller hospitals with clinical presentation of muscle and joint pain with fever. The muscle groups affected were different in all these cases. All four patients were transferred to this hospital due to the diagnostic dilemma between inflammatory and infective myositis. After a thorough workup including imaging and tissue diagnostics, they were labeled pyomyositis. This further stresses the need for physicians to become acquainted with this potentially life-threatening yet curable infective disease entity. The patients were managed with antibiotics for a minimum duration of 3 weeks and a maximum duration of 8 weeks for complete recovery. Pyomyositis in immunocompetent hosts was related to factors affecting the muscles without any strenuous exercise or direct trauma. Comprehensive evaluation of the muscles is facilitated by assessment of fluorodeoxyglucose uptake on positron emission tomography–computed tomography scan. The initial therapy consisting of cephalosporin and teicoplanin was found effective in our patients. The minimum length of in-hospital treatment was 4 weeks. This series further reinforces the fact that tropical pyomyositis is not exclusive to immunocompromised persons.