Multifocal neuropathy and Horner's syndrome due to disseminated pyomyositis in an intravenous drug user.

BACKGROUND: The formation of abscesses with necrosis within large, striated muscles leads to pyomyositis, a condition relatively rarely encountered outside the tropics. Intravenous drug users and other immunocompromised individuals are predisposed toward this infection, which may occur due to local or haematogenous spread of infection to skeletal muscles previously damaged by trauma, exercise, or rhabdomyolysis. METHODS: We report a young male intravenous drug user with rhabdomyolysis due to use of a synthetic opioid, in whom disseminated pyomyositis was detected following evaluation for sciatic and radial neuropathies and Horner's syndrome and review available reports of peripheral nerve dysfunction in the setting of this uncommon infection. We searched online databases to identify all published reports on adult patients with pyomyositis complicated by peripheral nerve dysfunction. CONCLUSIONS: Peripheral nerve dysfunction may rarely occur via local spread of infection or compression from abscesses.

Primary Bacterial Pyomyositis in Children: A Systematic Review.

BACKGROUND: Tropical pyomyositis has had a recent increase in the United States, Europe, and other nontropical areas. The purpose of this study was to provide an accurate description of the demographics, presenting features, sites of involvement, microbiology, imaging modalities, medical and surgical management, complications, and predictors of clinical course. METHODS: We searched PubMed, Cochrane, Web of Science Collection, Scopus, and Embase databases yielding 156 studies. Of these, 23 articles were selected for statistical analysis. RESULTS: The average age at presentation was 8.4±1.9 years with males more commonly affected. Fever, painful limp, and localized pain were the most common presenting symptoms. Pelvis, lower extremity, trunk and spine, in descending order, were the most commonly affected locations. Iliopsoas, obturator musculature, and gluteus musculature were the most commonly affected muscle groups. The mean time to diagnosis was 6.6±3.05 days. Staphylococcus aureus was the most common offending organism. The mean length of hospital stay was 12.0±4.6 days. Medical management alone was successful in 40% of cases (143/361) with an average duration of 9.5±4.0 and 22.7±7.2 days of intravenous and oral antibiotics, respectively. Surgical management consisted of open drainage in 91.3% (199/218) or percutaneous drainage in 8.7% (19/218) of cases. Painful limp, fever, and larger values of white cell count and erythrocyte sedimentation rate were associated with an increased need for surgery. Obturator and calf muscle involvement were strongly associated with multifocal involvement. There were 42 complications in 41 patients (11.3%). Methicillin-resistant S. aureus was associated with an increased risk of complications. The most common complications were osteomyelitis, septicemia, and septic arthritis. CONCLUSIONS: Primary pyomyositis should be considered in cases suggesting pediatric infection. Magnetic resonance imaging is the most commonly used imaging modality; however, ultrasound is useful given its accessibility and low cost. Medical management alone can be successful, but surgical treatment is often needed. The prognosis is favorable. Early diagnosis, appropriate medical management, and potential surgical drainage are required for effective treatment. LEVEL OF EVIDENCE: Level IV-systematic review.

Primary Pyomyositis in Children is No More a Rare Condition: Presentation of 2 Clinical Cases.

Primary pyomyositis is a bacterial muscle infection which may lead to abscess formation and severe complications. Although this condition has long been considered "tropical" and rare, mostly affecting immunocompromised patients, cases of pyomyositis have recently raised significantly among healthy children in temperate climates. With these 2 cases we highlight the importance of an early recognition of this condition, allowing an immediate treatment and reducing complications.

Candida albicans causing cervical pyomyositis: A case report / Piomiositis cervical por Candida albicans: A propósito de un caso

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Pyomyositis and muscle abscess due to Salmonella enteritidis in a patient with Behçet's syndrome: a case report.

Salmonella infections usually present with gastrointestinal manifestations including enterocolitis especially in immunocompromised patients. Haematogenous dissemination and abscesses are very rare complications of Salmonella species. This case report documents a patient with Behçet's syndrome (BS) who has pyomyositis due to Salmonella species. A 43-year-old male patient with BS presented to the outpatient rheumatology clinic with bilateral acute-onset lower extremity pain. However, over a short time the pain gradually increased and was accompanied by fever. The magnetic resonance scans demonstrated pyomyositis and muscle abscess in the adductor and obturator muscles. The cultures showed Salmonella enteritidis infection. The patient was successfully treated with antibiotic therapy. This case is important since it is one of the first in the literature to report an adult patient with BS and Salmonella pyomyositis.

Piriformis Pyomyositis Presenting as Migratory Hip to Knee Pain: A Case Report.

CASE: The authors report a case of piriformis pyomyositis in a teenage female patient with fever and left hip pain. Her pain migrated to the knee with concurrent near resolution of hip pain. Imaging revealed an abscess in the left piriformis with pus tracking along the sciatic nerve sheath. This was complicated by internal iliac vein thrombosis and an embolus to the lung. Open drainage was performed, followed by outpatient intravenous cloxacillin and oral warfarin, with complete resolution of symptoms. CONCLUSION: Piriformis pyomyositis is a rare condition with varying presentations. The threshold for suspicion should be low even in healthy young individuals.

Piomiositis secundaria a abscesos prostáticos / Pyomyositis secondary to prostatic abscesses

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Point-of-Care Ultrasound to Diagnose Pyomyositis in a Child.

We report a case of a patient presenting with fever, right lower leg swelling, and pain who was found to have a fluid collection between muscle planes noted on point-of-care ultrasound. Point-of-care ultrasound raised the clinician's concern for deep musculoskeletal infection, leading to prompt initiation of antibiotics and magnetic resonance imaging.

Pyomyositis Diagnosed by Point-of-Care Ultrasound in the Emergency Department.

BACKGROUND: Currently, the role of ultrasound in diagnosing superficial abscesses is well validated, however, its role for deep space infections and intramuscular pathology is limited. Distinguishing between simple cellulitis and abscess is critical for emergency physicians (EP), as the treatment is very different. Management of cellulitis relies on antibiotic therapy, whereas abscess treatment requires incision and drainage. It is important that EPs can accurately distinguish between the two entities. CASE REPORT: We report a case of a 41-year-old man with a history of high blood pressure and poorly controlled diabetes who presented with right lateral thigh redness, warmth, and tenderness. A point-of-care ultrasound (POCUS) of the patient's right lateral thigh with a high-frequency linear (8 MHz) ultrasound probe showed a 2.93 × 3.38 × 6.0-cm complex fluid collection deep to the fascial plane, approximately 3.0 cm from the skin surface, that contained mixed echogenicities with posterior acoustic enhancement consistent with an intramuscular abscess of the vastus lateralis. The patient was diagnosed with pyomyositis of his vastus lateralis. He was started on vancomycin and admitted to the surgical service for antibiotic treatment and surgical drainage. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: This case demonstrates that the use of POCUS by EPs can facilitate the rapid recognition and treatment of a disease that is challenging to diagnose on physical examination and can be potentially life-threatening if missed. EPs can consider performing a POCUS when evaluating skin infections to ensure rapid diagnosis and appropriate medical care for a potentially severe condition.

Piomiositis del músculo pectíneo. Descripción de un caso y revisión bibliográfica / Pectineus muscle pyomyositis. A case report and review of the literature

La piomiositis (PM) es una infección aguda bacteriana que afecta al músculo estriado, generalmente causada por Staphylococcus aureus y suele acompañarse de la formación de un absceso en el músculo. Esta entidad clínica fue descrita por primera vez en 1885 por Scriba1 como enfermedad endémica en los trópicos. En las últimas dos décadas se ha observado un incremento notable del número de casos en países de clima templado, probablemente asociado a un aumento de pacientes inmunodeprimidos. Las infecciones profundas de músculos pélvicos son difíciles de diagnosticar por ocasionar signos clínicos inespecíficos y que hacen pensaren otras patologías más comunes. Comunicamos el caso de una paciente de 33 años diabética que consultó por dolor inguinal acompañado de tumoración en la misma zona y fiebre de 4 días de evolución. Recibió tratamiento sintomático sin respuesta. La resonancia nuclear magnética pélvica fue compatible con piomiositis de músculo pectíneo. Recibió tratamiento antibiótico, evolucionando satisfactoriamente. La piomiositis es una entidad poco frecuente, que requiere un elevado índice de sospecha, para un adecuado diagnóstico y tratamiento, siendo la terapia antibiótica y drenaje en caso de absceso los pilares de éste último. Este tratamiento debe instaurarse de forma precoz, ya que su evolución puede ser potencialmente letal

Pyomyositis (PM) is an acute bacterial infection of skeletal muscle, usually caused by Staphilococcus Aureus and it is frenquently associated to a muscle abcess. This clinical entity was first described by Scriba1 at 1885 as a tropic endemic pathology. In the past two decades the number of cases at countries of temperate climate has rised notably due to the number of patients with inmunosuppression. Unfortunately, diagnosis of deep pelvic muscle infection is often delayed since they usually present with non-specific physical signs suggesting other more common diseases. The authors communicate a case of a diabetic33-year-old female who suffered inguinal acute pain and mass with history of fever since 4 days before. She initially received symptomatic treatment with no success. Pelvis magnetic resonance imaging showed pyomyositis of the piriformis muscle. Antibacterial treatment was administered, resulting in a good outcome. Pyomyositis is a rare condition that demands a high index of suspicion to make an adequate diagnosis and prompt treatment, including antibacterial treatment and drainage, particularly in case of abscess formation. This treatment should be established promptly since its outcome may be potentially lethal

Combined Labeled Leukocyte and Technicium 99 Sulfur Colloid Bone Marrow Imaging: Differentiating Primary Pyomyositis Pseudotumor from Osteomyelitis and Multiple Bone Infarcts.

A 53 year old-female patient with lupus had undergone a cephalo-medullary nailing for a femur shaft fracture 30 years ago. This was complicated by osteomyelitis, requiring multiple debridement procedures and hardware removal. Recently, she developed a painful soft tissue mass in the same region, which was ultimately diagnosed as pyomyositis. Because of chronic bone changes due to her past history, traditional imaging could not differentiate between osteomyelitis infarction and pseudotumor. A combined indium-labeled leukocyte scan with a technetium-99 sulfur colloid marrow scan ruled out osteomyelitis and guided proper treatment without osseous debridement and thus prevented unnecessary cross-contamination of the bone.