Case Of Pyomyositis Research Articles

Pyomyositis associated with abscess formation caused by streptococcus pneumoniae in children: a case report and review of literature

BackgroundPyomyositis is an unusual bacterial infection but potential severe in children. Staphylococcus Aureus is the main caused of this disease (70–90%), following by Streptococcus Pyogenes (4–16%). Streptococcus Pneumoniae rarely caused invasive muscular infections. We describe a case of pyomyositis caused by Streptococcus Pneumonia in an adolescent 12-year-old female.Case presentationI.L. referred to our hospital for high fever associated with right hip and abdominal pain. The blood exams showed increase of leukocytes with prevalence of neutrophils with high level of inflammatory markers (CRP 46,17 mg/dl; Procalcitonin 25,8 ng/ml). The abdomen ultrasonography was unremarkable. The CT and MRI of the abdomen and right hip revealed pyomyositis of the iliopsoas, piriformis and internal shutter associated with collection of pus between the muscular planes (Fig. 1). The patient was admitted to our paediatric care unit, and she was initially treatment with intravenous Ceftriaxone (100 mg/kg/day) and Vancomycin (60 mg/kg/day). On day 2, a pansensitive Streptococcus Pneumoniae was isolated from the blood culture, and the antibiotic treatment was changed to only IV Ceftriaxone. She was successively treated with IV Ceftriaxone for 3 weeks, then continued with oral Amoxicillin for a total of 6 weeks of therapy. The follow up showed a complete resolution of the pyomyositis and psoas abscess after 2 months.ConclusionPyomyositis associate with abscess is a rare and very dangerous disease in children. The clinical presentation can mimic symptoms of other pathologies like osteomyelitis or septic arthritis, so many times is hard to identify. The main risk factors include story of recent trauma and immunodeficiency, not present in our case report. The therapy involves the antibiotics and, if possible, abscess drainage. In literature there is much discussion about duration of antibiotic therapy.

Extraintestinal Salmonella InfectionsAn Underdiagnosed Clinical Entity: A Case Series

Extraintestinal salmonellosis can occur as a complication of enteric fever. In this case series, five clinically suspected cases of pyogenic meningitis and arthritis, a case of pyelonephritis suspected to be pyogenic or tubercular, a case of vertebral osteomyelitis suspected to be tuberculosis or malignancy, and a case of pyomyositis that clinically presented as a tumour were discussed. Although none of these cases were clinically suspected to be due to Salmonella, all were confirmed as extraintestinal salmonellosis based on microbiological evaluation. Salmonella should be suspected in acute inflammatory lesions that are unresponsive to empirical treatment. Instead of empirical antibiotics, culture and sensitivity-based antibiotics for the recommended duration are the only way to cure extraintestinal salmonellosis and prevent morbidity. Effective communication and correlation between the laboratory, clinician, and radiologist are essential for a definitive diagnosis. Histopathological and microbiological investigations should be done simultaneously to identify the definitive aetiology in all localised lesions presenting with necrosis/inflammatory response. This case series presents five cases of extraintestinal salmonellosis with serious complications, including meningitis, pyelonephritis, osteomyelitis, septic arthritis, and pyomyositis, each with varied clinical presentations.

Pyomyositis after COVID-19 vaccine and Why Does This Infection Not Respond to Antibiotics Treatment?

Introduction: Pyomyositis is a bacterial infection caused mainly by gram-positive bacteria of the skeletal muscle and can lead to abscess formation. In this article, I will show one case of pyomyositis after receiving the COVID-19 vaccine that does not improve with the use of antibiotics. Purpose: the purpose of this study is to show another type of pyomyositis induced by the injection of the COVID-19 vaccine in a patient with energy deficiency in the internal five massive organs, responsible for the production of Yin, Yang, Qi, and Blood, important to maintaining our health and the reduction of these energies caused by the injected vaccine caused the formation of internal Heat or Fire, leading to clinical manifestation of infectious symptoms, in this case, pyomyositis. Methods: one case report of 72 years-old female patients with chronic pyomyositis formation in the left coxofemoral region since 2020, that began after the second dose of the COVID-19 vaccine. She was submitted to antibiotics and drainage of the infection and abscess formation since the beginning of this infection without any improvement of her infection symptoms (the last antibiotics used was vancomycin for 4 weeks). The infectious disease doctor told her that he does not have any other kind of treatment to do in her case. It was measured her internal five massive organs’ energy (Liver, Heart, Spleen, Lungs, and Kidney) using a crystal pendulum when she went to my clinic. Results: all her internal massive organs were in the lowest level of energy, rated one out of eight. The treatment of her condition consisted of Chinese dietary counseling, auricular acupuncture with apex ear bloodletting, systemic acupuncture, and homeopathy medications called Sulphur 6CH 5 globules three times per day. It also used homeopathy medications according to the theory Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine and crystal-based medications. It was suspended all antibiotics medications that were worsening her clinical condition. All tools used were important to complete recovery of her infection without using any kind of antibiotics. Conclusion: the conclusion of this study is that patients with pyomyositis after the COVID-19 vaccine were caused due to energy deficiency in the five massive organs that the patient had prior to the COVID-19 vaccine and the use of this type of vaccine caused a drop even more of the internal energy, that was already very low, leading to the formation of Heat retention or Fire and formation of infectious process symptoms, in this case, pyomyositis. The treatment of this condition, rebalancing these energies and taking out the Heat (using an appropriate diet and apex ear bloodletting), and replenishing the internal five massive organs using homeopathy medications according to the theory Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine and crystal-based medications are very important tools used in this patient and also, the suspension of all antibiotics use to the treatment of this infection at the beginning of her clinical manifestation was important to do not reduce even more the internal energy, that was already very low, leading to worsening of production of internal Fire, causing the manifestation of pain and infection inside the muscle.

From sciatica pain to a complex diagnosis: a case of pyomyositis and chronic lymphocytic leukemia

We described a case of a 50-year-old man who presented severe low back and leg pain that quickly evolved in severe septic shock. Clinical workouts led us to diagnose a rare condition as pyomyositis because of the identification of Staphylococcus aureus septicemia and multiple muscle collections. Although this rare condition rarely occurs in temperate climates, its prevalence recently increased and is often associated with an immunocompromised condition. In this case, the investigation of an immunological impairment revealed an underlying chronic lymphocytic leukemia/small cell non-Hodgkin lymphoma.

Answer to October 2021 Photo Quiz.

We report an unusual pyomyositis with concomitant pulmonary lesions in an HIV-positive patient. Due to the difficulty of collecting sputum, gastric lavage was performed. The abscess in the leg was drained (Fig. 1B in photo quiz case presentation). The gastric lavage and the abscess drainage were analyzed using an acid-fast bacilli smear (Fig. 1C in photo quiz case presentation) and Xpert MTB/RIF assay. Gastric lavage, purulent drainage, and blood culture were positive for Mycobacterium tuberculosis. The typical formation of serpentine cords was demonstrated upon culture of abscess drainage (Fig. 1D in photo quiz case presentation). Gastric lavage was M. tuberculosis nucleic acid positive by Xpert MTB/RIF assay. The diagnosis of tuberculosis (TB) pyomyositis was confirmed. Anti-TB therapy (rifampin) was started. Pyomyositis is the accumulation of purulent material within individual muscle groups, and the most common organisms implicated in pyomyositis include Staphylococcus aureus (1). Typical cases of pyomyositis involve fever and pain, which are specific to a muscle group, generally the lower extremities (1, 2). TB pyomyositis, defined as M. tuberculosis infection of skeletal muscle, is more common in immunocompromised patients, but even in these patients, it is considered to be a rare extrapulmonary manifestation of TB. The clinical manifestations may be insidious, with nonspecific symptoms, such as fever, night sweats, malaise, and weight loss (3). Ohnishi et al. reported three cases of TB pyomyositis in women coinfected with TB/HIV with a CD4 below 200 cells/mm3 (4). Pathogenesis for TB pyomyositis can include contiguous spread, lymphatic or hematogenous spread, and direct inoculation (3, 5). We hypothesize that in this case it was a hematogenous spread because of the absence of trauma or infection, with no evidence of osteomyelitis. TB pyomyositis is very difficult to clinically diagnose and distinguish from other soft tissue diseases. Diagnosis depends on a high clinical suspicion of infection in a susceptible population. TB should be considered in patients who present with soft tissue swelling and pain, particularly if they have an abnormal chest X-ray (6). Drainage through surgery and aggressive anti-TB therapy is normally required (7). The case presented here is noteworthy given the rarity of this manifestation of TB and highlights the need for early diagnosis. With timely diagnosis and adequate clinical and surgical treatment, the prognosis is good. Prompt diagnosis requires a high index of suspicion, especially in immunocompromised patients. Fluid cultures should be sent for acid-fast bacilli staining (Fig. 1C in photo quiz case presentation) and culture (8). In laboratories serving areas of high M. tuberculosis incidence with limited economic resources, cord factor detection (Fig. 1D in photo quiz case presentation) is a fast and valid criterion for identifying these mycobacteria using liquid or solid medium (9).

Pyomyositis bij een niertransplantatiepatiënt na het doormaken van een diepe veneuze trombose

Pyomyositis in a renal transplant patient after experiencing a venous thromboembolism Pyomyositis is a bacterial infection of skeletal muscle tissue that results in localized abscess formation. In the past this disease was endemic to tropical areas, but in recent decades the number of cases in temperate climates has been increasing. The diagnosis is difficult and often delayed. Diagnosis can be made by MRI. Treatment consists of surgery and intravenous antibiotics. In this case report a 75-year-old renal transplant patient was diagnosed with pyomyositis after experiencing a venous thromboembolism (VTE). Despite the rarity of this syndrome, pyomyositis is more often described in the relevant literature than one would expect. Confounding factors in this case were the recent experience of VTE, as well as an existing lumboischialgia; risk factors were the immunosuppressive status, diabetes mellitus and the recent VTE. Noteworthy with this case of pyomyositis was the atypical germ and muscle group. Finally, the further course of the disease in this case made clear that the possible side effects of a therapy should always be considered when starting treatment.

Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study.

BackgroundPyomyositis is a bacterial infection of skeletal muscle that classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years.MethodsTo better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020.ResultsThe mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Approximately half of all patients received >1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%.ConclusionsGram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies that prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.

The Utility of Musculoskeletal Ultrasonography in Diagnosing Pyomyositis: A Comparison With Surgically and Conservatively Treated Cases

Objective: The study aimed to determine the accuracy of sonography in diagnosing pyomyositis. Methods: A retrospective review of pyomyositis cases in a government hospital between January 1, 2016 and June 30, 2019 was done. All cases underwent a sonogram for the indication of pyomyositis. Positive purulence for surgical cases and improved laboratory parameters for conservative cases were confirmatory for pyomyositis. Comparison with sonographic results using a 2 × 2 contingency table was done to determine sensitivity and specificity. Results: A total of 122 cases were included. The sonographic results corresponded with 95% of surgical cases and 89% of conservative cases. A lack of false and true negatives for surgical cases resulted in a sensitivity of 100% (95% confidence interval [CI] = 93%–100%) and a specificity of 0% (95% CI = 0%–71%). In conservative cases, sonography had a sensitivity of 92% (95% CI = 82%–97%) and a specificity of 0% (95% CI = 0%–84%) due to a lack of true negatives. Conclusion: Sonography is not limited to primarily as a screening tool but a capable diagnostic imaging choice for pyomyositis, particularly in low-resource settings. The results show the strength of sonography, particularly in the suppurative stage of pyomyositis. [Box: see text]

A case of pyomyositis caused by Streptococcus pyogenes in paravertebral muscle

A case of pyomyositis caused by Streptococcus pyogenes in paravertebral muscle

A Case of Pyomyositis of the Pectoralis Major Muscle with Abscesses in the Thoracic Cavity Caused by <i>Staphylococcus schleiferi </i>

A Case of Pyomyositis of the Pectoralis Major Muscle with Abscesses in the Thoracic Cavity Caused by <i>Staphylococcus schleiferi </i>

765. Pyomyositis in the United States: Trends and Associations From the Healthcare Utilization Project Nationwide Inpatient Sample Database

BackgroundPyomyositis is a spontaneous infection of skeletal muscle that can lead to abscess formation and sepsis. The purpose of our study was to better describe the characteristics, risk factors, and trends of primary pyomyositis in the United States.MethodsThis study is a retrospective review of data from the Healthcare Utilization Project Nationwide Inpatient Sample Database from 2002 to 2014. We systematically searched ICD-9 codes and included diagnoses of infective myositis and/or tropical pyomyositis and excluded progressive myositis ossificans and/or traumatic myositis ossificans. We compiled lists of codes for co-occurring infections, candidate risk factors, and microbiological data. Each group of related ICD-9 codes was combined into a single composite indicator. SAS studio was utilized for analysis.ResultsThe database included a total of 100,790,900 discharges accounting for 482,872,274 weighted discharges with 13,011 pyomyositis cases accounting for 62,657 weighted cases. The patients with pyomyositis were significantly more likely to be younger, male, and have a longer duration of hospitalization. The proportion of discharges with pyomyositis has steadily risen more than 3-fold from 0.0054% to 0.0209%. Of the cases of pyomyositis, a minority had co-occurring deep tissue infections: 16.9% had osteomyelitis and 8.8% had septic arthritis. We found significantly higher rates of co-occurrence with HIV, diabetes mellitus, organ transplant, alcohol abuse, and chronic kidney disease compared with the general hospitalized population, suggesting these as relevant risk factors. When microorganisms were diagnosed, Staphylococus aureus was most common, followed by Streptococcus spp.ConclusionOur study identified a rapid increase in pyomyositis cases in the United States over our 12-year study period. Our results substantiate risk factors for pyomyositis related to immunosuppression and suggest that diabetes mellitus may be an important risk factor in the United States. Identifying causative organisms is helpful for empiric treatment. It is important that clinicians be aware of this emerging diagnosis relevant in both temperate and tropical areas of the globe. Disclosures All authors: No reported disclosures.

Bacterial Pyomyositis Associated with Human Immunodeficiency Virus: Diagnosis, Management, and Review of the Recent Literature

We present a case and provide a review of all the confirmed cases of pyomyositis in human immunodeficiency virus (HIV)-positive patients in the literature after the last published case series, from September 16, 2004 to February 1, 2019. The goal of this review is to examine recent trends in causative organisms, diagnostic modalities, and duration of therapy for patients with HIV and pyomyositis in the antiretroviral therapy (ART) era. Pyomyositis affects predominately the lower extremities and can have extra-muscular manifestations. Magnetic resonance imaging is the gold standard for diagnosis but computed topography may be sufficient. Without appropriate clinical suspicion, pyomyositis can be misdiagnosed. HIV remains an important risk factor to develop pyomyositis. While magnetic resonance imaging is the preferred diagnostic imaging modality, computed tomography may also be sufficient. Treatment is non-standardized and consists of surgical source control coupled with systemic intravenous and oral antibiotics of variable duration.

Pyomyositis in a Patient with IgA Nephropathy and Kidney Transplant

Infections are among the most common complications transplant physicians face when dealing with solid organ transplant recipients. We present a case of pyomyositis caused by Staphylococcus aureus in a patient with IgA nephropathy and a kidney transplant, under treatment with mTOR inhibitors and prednisone. This entity is a rare intramuscular infection, given the resistance of healthy muscle to colonization. We review the most frequent agents, the diagnostic algorithm, and therapeutic alternatives. We also comment on the role of mTOR inhibitors in this case as possible predisposing factor for the infection.

Reverse Lemierre\u2019s syndrome: a case report

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).

Tropical Pyomyositis: Case Report

The first case of pyomyositis was described by Scriba in the 19th century, being found endemically in tropical regions. Until recently, pyomyositis was considered uncommon in the temperate zone. Currently there is an increase in the number of cases of pyomyositis in temperate climates.

Northern tropics? Seven cases of pyomyositis in northwestern Ontario

OBJECTIVE: To document the incidence and clinical characteristics of (tropical) pyomyositis in a predominantly First Nations population in northwestern Ontario. METHODS: The present study was a retrospective case series conducted over a 38-month period in a population of 29,105 in northwestern Ontario. RESULTS: The authors identified seven cases of pyomyositis and describe demographics, comorbidity, clinical course, and the results of imaging and microbiology investigations. The incidence of pyomyositis in northwestern Ontario is 7.6 cases per 100,000 person-years, a rate that is approximately 15 times higher than the only published incidence rate for a developed country (Australia). CONCLUSION: The rate of pyomyositis is high. It may be mediated by overcrowded housing, inadequate access to clean water, and high background rates of methicillin-resistant Staphylococcus aureus infection, injection drug use, and type 2 diabetes mellitus.

Extraintestinal Salmonellosis in the Immunocompromised: An Unusual Case of Pyomyositis

Salmonella infection can cause a wide range of presentations, predominantly gastrointestinal but occasionally with cardiovascular or other extraintestinal manifestations. The diagnosis of extraintestinal salmonellosis requires a high degree of clinical suspicion and should be considered in patients with deep-seated abscesses especially if they are immunocompromised. We present a case of salmonella causing gastroenteritis complicated by an intramuscular abscess of the left leg. With prompt recognition and multidisciplinary management, the patient recovered with no serious sequela.

Bilateral Neck Pyomyositis Caused byStaphylococcus capitisandStaphylococcus saccharolyticusin a Diabetic Adult

We report a case of pyomyositis of the paraspinal neck muscles caused by two coagulase-negative staphylococci: Staphylococcus capitis and Staphylococcus saccharolyticus. Inflammation in the spermatic cords was an additional feature of this infection. Treatment with six weeks of first-generation cephalosporin therapy resulted in complete clinical and radiological resolution.

Primary Bacterial Gluteal Pyomyositis: A Rare Disease in Temperate Climates Presenting as Suspected Septic Arthritis of the Hip

BackgroundIn nations with temperate climates, primary polymyositis is a rare, life-threatening bacterial infection that can mimic various clinical diseases depending on the area involved, leading to delayed diagnosis and management. Case ReportWe describe a young postpartum woman who presented to the emergency department with hip pain that was initially suspected to be caused by septic arthritis. However, hip arthrocentesis was negative, and a magnetic resonance imaging scan revealed extensive pyomyositis of the gluteal muscles. She underwent surgical debridement and was given parenteral antibiotics with good clinical recovery. Why Should An Emergency Physician Be Aware of This?We emphasize that cases of pyomyositis in temperate countries are often diagnosed late and therefore delay life- and potentially limb-saving treatment. For patients who present with hip and thigh pain and clinical features of sepsis, pyomyositis should be considered in the differential diagnosis and an early magnetic resonance imaging scan should be performed to confirm the diagnosis and reduce the high morbidity and mortality associated with this emerging disease.

Arm Pain and Erythema

Pyomyositis can be a difficult diagnosis to make, as it can mimic many other disease processes. Various laboratory studies can be abnormal with pyomyositis, but none are specific to the disease. Early disease can generally be treated with antibiotics alone, whereas advanced disease frequently requires emergent surgical intervention with significant resuscitation. We describe a case of pyomyositis of the right arm.