Severe thoracic pyomyositis in a patient with systemic lupus erythematosus.

Pyomyositis may mimic deep vein thrombosis and be misdiagnosed in patients with systemic lupus erythematosus (SLE). We report here on patient with SLE with severe thoracic pyomyositis presented with right upper arm swelling and fever. The patient fully recovered after a serial surgical debridement and antibiotic therapy. Pyomyositis, as well as deep vein thrombosis, should be considered during the differential diagnosis of patients with SLE experiencing fever and unilateral limb oedema. CT and identification of causal pathogens are crucial in the diagnosis of pyomyositis. Early effective antibiotic treatment as well as surgical intervention can together bring about a better outcome.

Hepatocellular Carcinoma-Associated Polymyositis Presenting With Unilateral Upper Limb Subcutaneous Edema.

Localized subcutaneous edema is a rare manifestation of inflammatory myopathy. In general, the incidence of malignancy in dermatomyositis is higher than that in polymyositis (PM). The association between malignancy and dermatomyositis has been established; however, it is less convincing in PM. In this article, we report on a case of malignancy-associated PM with an initial presentation of localized subcutaneous edema. A 66-year-old male patient with a history of chronic hepatitis B was presented to us with both left arm swelling and progressive proximal muscle weakness. A multi-detector row computed tomography showed prominent left arm edema, while a venography demonstrated no venous thrombosis or stenosis. A diagnosis of PM was established according to its typical symptoms, high serum creatine kinase level, positive electromyography findings, and systemic inflammatory signs. Magnetic resonance imaging of the liver revealed infiltrative hepatocellular carcinoma. After undergoing systemic corticosteroid therapy, in combination with hydroxychloroquine, the left arm edema was resolved. However, patient died from hepatocellular carcinoma three months after the date of diagnosis. It is important to recognize that hepatocellular carcinoma-associated PM may initially present itself with localized non-pitting edema. Although such localized edema may be responsive to corticosteroids, a patient's overall prognosis remains poor. We presume that PM with localized subcutaneous edema may be a predictor of malignancy, and therefore recommend a tumor survey.