Tuberculous Pyomyositis Masquerading as Pyogenic Infection: A Case Report.

Abstract

Tuberculous pyomyositis is a rare entity, with nonspecific presentation that often leads to a delay in diagnosis. It is caused by a small aerophilic bacillus organism and spreads by exhaled respiratory droplets from affected individuals. When tuberculous pyomyositis presents as the initial and only manifestation of the disease, there is a diagnostic dilemma. Even with readily available advanced imaging studies, there are no pathognomonic findings indicative of the disease. Early and accurate recognition is essential to avoid additional morbidity, mortality, and public health risk. Tuberculous pyomyositis has been reported as an opportunistic infection in patients with immunosuppression. Modern manifestations have been unmasked following medical therapy for respiratory infections treated with quinolone antibiotics1. It may present as painful soft-tissue swelling with conditions such as ankylosing spondylitis2, rheumatoid arthritis3, and polymyositis4. There is an increased incidence in individuals who are being treated with corticosteroids and disease-modifying antirheumatic drugs (DMARDS)5, and, paradoxically, in individuals with human immunodeficiency virus (HIV)6 that is being brought into remission with medication therapy7. There is an increased incidence in people who may be immunocompromised or who have a number of medical comorbidities, including diabetes mellitus, congestive heart failure, renal failure, drug addiction, systemic lupus erythematosis, nephrotic syndrome, and renal transplant. To the best of our knowledge, much of the literature pertaining to these conditions has been published from areas where tuberculosis (TB) is endemic. However, the defined patient population at risk is not necessarily defined by the pulmonary TB population, but rather by a population that is common in most hospitals in the United States. The reported outcomes of tuberculous pyomyositis have varied widely, from complete disease remission to death. Early accurate diagnostic consideration is important in optimizing outcomes. With this report, …