ABSTRACT
Musculoskeletal tuberculosis (TB) occurs in only 3% of patients with TB while tuberculous pyomyositis is rare. It usually affects immunocompromised or patients with underlying comorbidities. We present a case of tuberculous pyomyositis in a 85-year-old Caucasian patient with rheumatoid arthritis (RA) treated with steroids and anakinra. The patient presented with fever as well as redness, swelling and induration on the lateral side of the hip and thigh. Under ultrasound guidance fluid collection of the thigh was aspirated. Polymerase chain reaction (PCR) and cultures of the fluid were positive for Mycobacterium TB. The patient underwent bronchoscopy. PCR and cultures from the bronchoalveolar lavage were also positive for Mycobacterium TB. The patient was treated with anti TB treatment with amelioration of the inflammation in the hip and thigh. This is the first reported case of tuberculous pyomyositis in a RA patient treated with anakinra.
Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Interleukin 1 Receptor Antagonist Protein/adverse effects , Opportunistic Infections/chemically induced , Pyomyositis/chemically induced , Tuberculosis/chemically induced , Aged, 80 and over , Antitubercular Agents/therapeutic use , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/immunology , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Opportunistic Infections/microbiology , Pyomyositis/diagnosis , Pyomyositis/drug therapy , Pyomyositis/immunology , Pyomyositis/microbiology , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/immunology , Tuberculosis/microbiologyABSTRACT
Pyomyositis is a rare complication of chemotherapy for non-hematological malignancies. A 58-year-old woman with endometrial carcinoma, in whom pyomyositis developed during adjuvant chemotherapy, was presented in this report. After initiating empiric antibiotic therapy for febrile neutrocytopenia, screening CT showed multiple abscesses in the lower limbs. Operative drainage of the abscess was effective.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Endometrial Neoplasms/drug therapy , Pyomyositis/chemically induced , Abscess/chemically induced , Abscess/drug therapy , Carboplatin/administration & dosage , Chemotherapy, Adjuvant , Docetaxel , Drainage , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Prognosis , Pyomyositis/drug therapy , Taxoids/administration & dosageSubject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Magnetic Resonance Imaging , Pyomyositis/chemically induced , Pyomyositis/pathology , Antibodies, Monoclonal, Humanized/administration & dosage , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/adverse effects , Humans , Male , Middle Aged , Staphylococcal Infections/chemically induced , Staphylococcal Infections/pathology , Thumb/pathologyABSTRACT
We report a case of a 69-year-old man who developed tetraparesis and muscular pain under the therapy of prednisolone for several months. Diagnosis was sepsis due to pyomyositis with multiple septic pulmonary staphylococcus aureus abscesses. Antibiotic therapy with piperacillin and tazobactam resulted in a decrease of the inflammatory factors and improvement of the tetraparesis. Pyomyositis, common in tropical areas, is a suppurative infection of striated muscle. Immunodeficiency has been implicated in the development of pyomyositis in temperate climates.
Subject(s)
Paresis/chemically induced , Paresis/diagnosis , Pneumonia, Bacterial/chemically induced , Pneumonia, Bacterial/diagnosis , Prednisolone/adverse effects , Pyomyositis/chemically induced , Pyomyositis/diagnosis , Aged , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Humans , Immunosuppressive Agents/adverse effects , Male , Paresis/drug therapy , Pneumonia, Bacterial/drug therapy , Pyomyositis/drug therapy , Treatment OutcomeABSTRACT
A 55-year-old woman with rheumatoid arthritis having 4 months previously received two doses of infliximab, presented with fever, hypotension and swelling of right thigh posterolaterally. CT-guided aspiration was performed from the right thigh and revealed acid-fast bacilli (AFB) +++ and mycobacterial culture grew Mycobacterium tuberculosis. The patient improved on anti-tubercular treatment.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Pyomyositis/chemically induced , Tuberculosis/chemically induced , Antitubercular Agents/therapeutic use , Drug Therapy, Combination , Female , Humans , Infliximab , Magnetic Resonance Imaging , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Pyomyositis/diagnosis , Pyomyositis/drug therapy , Pyomyositis/microbiology , Thigh , Treatment Outcome , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/microbiologyABSTRACT
Pyomyositis is a rare complication of chemotherapy that is commonly seen in tropical climates and in patients with immunodeficiency states. Owing to its rarity and subacute presentation, its diagnosis is often delayed. It has been reported after intense chemotherapy for hematological cancers. We present a case of a 58-year-old woman with endometrial cancer who developed pyomyositis after the first cycle of carboplatin and paclitaxel with no prior predisposing factor except for cancer and premedication with corticosteroids. The patient improved once the diagnosis was established and managed with antibiotics and drainage of abscess. Full recovery was made with a protracted course of antibiotics.Early diagnosis of this entity with appropriate investigations and treatment prevents septicemia, which can often be life threatening.
