A case of extraocular muscle pyomyositis in an elderly patient with diabetes mellitus.

Pyomyositis is a bacterial infection of skeletal muscle leading to abscess formation. Younger males are predominantly involved, but pyomyositis may occur in all ages and sexes. Underlying systemic disease or accompanying immunocompromised states may increase the risk of pyomyositis. This is a report of a 72-year-old, male, with uncontrolled diabetes mellitus, presenting initially as a case of orbital cellulitis. Magnetic resonance imaging confirmed the presence of an abscess in the left lateral rectus. Antibiotic therapy was promptly initiated, and drainage of the abscess was performed via a transconjunctival approach. Pyomyositis resolved post-surgery and medical therapy. Residual exotropia was noted at the eighth month of follow-up necessitating subsequent strabismus surgery. Nine months post-treatment, left lateral rectus pyomyositis did not recur.

Dysphagia and Trismus After Tooth Extraction : Clinical Conondrum.

Clinicians should consider disorders of masticatory muscle including lateral pterygoid muscle as a differential diagnosis in patients presenting with dysphagia and trismus after tooth extraction.

Aseptic pyomyositis in rheumatoid arthritis treated with corticosteroid and DMARDs.

Pyomyositis is a purulent infection of skeletal muscle that is mostly observed in tropical countries. Aseptic pyomyositis is a rare, potentially life-threatening disorder characterized by the formation of sterile pus in muscle. We present a case of 53-years old female, diagnosed case of seropositive rheumatoid arthritis, presented with pain and swelling of the right calf muscle for 2 weeks. There was no history of fever, cough, skin erythema, no history of prolonged standing or immobility, or fetal loss. The diagnosis was made as rheumatoid arthritis with autoimmune pyomyositis, and the patient was treated with oral prednisolone 1mg/kg body weight in tapering dose, cs DMARDS, (methotrexate 25 mg once a week, and leflunomide 20mg daily hydroxychloroquine 200 mg daily orally) and another supportive treatment along with surgical drainage of pus was done. There was complete resolution of the initial lesion and remission of the primary disease in 3 months.

Case report: A case of piriformis pyomyositis and pyogenic sacroiliitis due to non-typhoidal Salmonella bacteremia in an immunocompetent healthy adult.

Non-typhoidal Salmonella (NTS) rarely causes bacteremia and subsequent focal infections as an extraintestinal complication, even in immunocompetent adults. A 25-year-old man was hospitalized for several days with difficulty moving due to fever, acute buttock pain, and shivering. He had no recent or current respiratory symptoms and no clear gastrointestinal symptoms. Physical examination revealed mild redness around the left buttock and difficulty raising the left lower extremity due to pain, in addition to which blood tests showed high levels of inflammatory markers. His clinical course and laboratory findings suggested sepsis, and magnetic resonance imaging revealed a high-intensity area in the left piriformis muscle on diffusion-weighted imaging; therefore, acute piriformis pyomyositis was strongly suggested. Cephazolin was started upon hospitalization; however, blood and stool cultures proved positive for NTS, and the antibiotics were changed to ceftriaxone. Follow-up MRI showed a signal in the left piriformis muscle and newly developed left pyogenic sacroiliitis. On the 25th hospital day, a colonoscopy was performed to identify the portal of entry for bacteremia, which revealed a longitudinal ulcer in the sigmoid colon in the healing process. His buttock pain gradually improved, and the antibiotics were switched to oral levofloxacin, which enabled him to continue treatment in an outpatient setting. Finally, the patient completed seven weeks of antimicrobial therapy and returned to daily life without leaving any residual disability. Invasive NTS infection due to bacteremia is rare among immunocompetent adults. Piriformis pyomyositis and subsequent pyogenic sacroiliitis should be added to the differential diagnosis of acute febrile buttock pain. In the case of NTS bacteremia, the entry site must be identified for source control. Additionally, the background of the host, especially in such an immunocompetent case, needs to be clarified; therefore, the patient should be closely examined.

Nocardia brasiliensis Pyomyositis in an Immunocompetent Patient Following Gardening Activity.

Nocardia pyomyositis in immunocompetent patients is a rare occurrence. The diagnosis may be missed or delayed with the risk of progressive infection and suboptimal or inappropriate treatment. We present the case of a 48-year-old immunocompetent firefighter diagnosed with pyomyositis caused by Nocardia brasiliensis acquired by direct skin inoculation from gardening activity. The patient developed a painful swelling on his right forearm that rapidly progressed proximally and deeper into the underlying muscle layer. Ultrasound imaging of his right forearm showed a 7-mm subcutaneous fluid collection with surrounding edema. Microbiologic analysis of the draining pus was confirmed to be N brasiliensis by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry. After incision and drainage deep to the muscle layer to evacuate the abscess and a few ineffective antibiotic options, the patient was treated with intravenous ceftriaxone and oral linezolid for 6 weeks. He was then de-escalated to oral moxifloxacin for an additional 4 months to complete a total antibiotic treatment duration of 6 months. The wound healed satisfactorily and was completely closed by the fourth month of antibiotic therapy. Six months after discontinuation of antibiotics, the patient continued to do well with complete resolution of the infection. In this article, we discussed the risk factors for Nocardia in immunocompetent settings, the occupational risks for Nocardia in our index patient, and the challenges encountered with diagnosis and treatment. Nocardia should be included in the differential diagnosis of cutaneous infections, particularly if there is no improvement of "cellulitis" with traditional antimicrobial regimens and the infection extends into the deeper muscle tissues.

Isolated Pyomyositis of the Thigh With a Sinus Tract: A Rare Presentation of Tuberculosis.

Muscular tuberculosis as a primary focal lesion in an immunocompetent individual without any underlying bone involvement is a rare finding. The authors present a case of a young female in her 30s who presented with complaints of recurrent discharging sinus in the posteromedial aspect of the proximal right thigh for eight months. The patient was treated by surgical debridement followed by antitubercular therapy (ATT) and has shown full recovery during the post-eight-month treatment period. Such a presentation of primary tubercular pyomyositis imposes a diagnostic as well as a therapeutic challenge.

Subscapularis pyomyositis, a rare cause of shoulder pain, in a patient without apparent risk factors: A case report.

INTRODUCTION: Pyomyositis, previously tropical, now seen more in temperate zones, particularly in those with HIV, cancer, or diabetes. Even healthy individuals, like athletes, can get it post-exercise or minor injuries. Our patient, in a desert-like area, adds an interesting aspect. Diagnosing is challenging due to deep tissue occurrence and subtle symptoms, leading to delayed detection and higher risks of morbidity. PRESENTATION OF CASE: A 45-year-old female patient presented with acute left shoulder pain and functional impairment, exacerbated by movement. Clinical examination revealed tenderness upon deep palpation in the left upper posterior thoracic region and restricted range of motion of the affected shoulder. DISCUSSION: Initial assessments at medical facilities suggested musculoskeletal strain and lower cervical disc prolapse despite normal X-ray results. MRI scans confirmed a developing abscess in the left subscapularis muscle, with intraoperative findings revealing extensive purulent fluid and necrotic tissue. Four surgeries drained the abscess and treated fat necrosis, with tailored antibiotics administered. Subsequent arthroscopy showed fibrous tissue, swelling, and inflammation. At the 3-month check-up, she had fully recovered, experiencing no pain or complications, and had almost regained full range of motion. CONCLUSION: Shoulder pyomyositis presents diagnostic challenges, causing delayed treatment. This case highlights the importance of considering pyomyositis in severe shoulder pain cases, even without typical risk factors or inconclusive X-rays. Timely recognition, surgical drainage, tailored antibiotics, and physical therapy are crucial. An interdisciplinary approach with orthopaedic surgery, infectious disease specialists, radiology, and physical therapy is vital for comprehensive management, improving outcomes, and reducing complications.

Imaging features of soft-tissue infections.

Skin and soft tissues are among the most common sites of infections. Infections can involve the superficial epidermis to deep muscles and bones. Most infections spread through contiguous structures, although hematogenous spread can occur in the setting of an immunocompromised state and with atypical infections. While clinical diagnosis of infections is possible, it often lacks specificity, necessitating the use of imaging for confirmation. Cross-sectional imaging with US, CT, and MRI is frequently performed not just for diagnosis, but to delineate the extent of infection and to aid in management. Nonetheless, the imaging features have considerable overlap, and as such, it is essential to integrate imaging features with clinical features for managing soft tissue infections. Radiologists must be aware of the imaging features of different infections and their mimics, as well as the pros and cons of each imaging technique to properly use them for appropriate clinical situations. In this review, we summarize the most recent evidence-based features of key soft tissue infections.

Subscapular abscesses: A literature review and evidence-based treatment guidelines.

Background: An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction. Methods: A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case. Results: Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach. Discussion and conclusions: From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.

Understanding limb necrotizing infections: A comprehensive approach.

INTRODUCTION: Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain. METHODS: A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients. RESULTS: Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%. CONCLUSIONS: We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.

Staphylococcus aureus Bacteremia With Disseminated Multiple Foci and Pyomyositis in an Immunocompetent Patient: A Case Report.

Pyomyositis is an uncommon primary infection of skeletal muscle resulting in muscle inflammation followed by pus formation. Pyomyositis is typically caused by Staphylococcus aureus (S. aureus), and most cases are associated with skin penetration and/or immunosuppressive conditions in tropical or even temperate climates. We report a previously healthy, immunocompetent 44-year-old man who presented with fever and right lower back pain. He had received an analgesic injection for his back pain 12 days prior to this visit. His clinical course was further complicated by the coexistence of multiple muscular abscesses, renal infarction, and septic arthritis of the right shoulder. He underwent computed tomography-guided drainage of the abscess. The abscess and blood cultures were positive for methicillin-susceptible S. aureus. The patient responded well to prolonged treatment with cefazolin and cephalexin and was discharged 12 weeks after initial admission.

Pectoralis Major Pyomyositis in a Patient With Diabetes: A Case Report and Literature Review.

Pyogenic myositis is a bacterial infection of skeletal muscle that is usually caused by Staphylococcus aureus and is common in tropical regions. Recently, this infection has also been reported in immunocompromised patients in temperate regions. The lower extremities and trunk are most affected, while involvement of the chest wall is rare. We report a case of pectoralis major pyomyositis caused by Morganella morganii in an 82-year-old Japanese man with type 2 diabetes mellitus who had undergone stenting for myocardial infarction. Four months prior to visiting our hospital, the patient became aware of pain in the right chest area, which gradually became swollen. One month before the visit, the pain and swelling had become more severe. At the visit, there was swelling in the right anterior thoracic region with a diameter of 10 cm and pain in the same region. On physical examination, his blood pressure was 133/64 mmHg, heart rate was 83 beats/min, and body temperature was 36.9℃. Initially, a sarcoma or other neoplastic lesion was suspected and a needle biopsy was performed. Pus was drained from the puncture site to collect wound culture. Needle biopsy of the lesion did not reveal any fungi or acid-fast bacteria, and a T-SPOT.TB test was negative. Computed tomography and magnetic resonance imaging suggested abscess formation under the pectoralis major muscle. A wound culture test detected Morganella morganii, and pectoralis major pyomyositis was diagnosed. Debridement was performed under general anesthesia. The necrotic pectoralis major muscle was excised, the abscess cavity was opened, and wound irrigation was performed. The postoperative course was good and the patient was discharged on the 16th postoperative day. There has been no recurrence in eight months postoperatively. Pectoralis major pyomyositis may not be relieved by antibiotics alone and may extend to deeper organs to form intrapleural abscesses. Therefore, prompt drainage should be performed to prevent serious complications in a case in which abscess formation is observed.

Pyomyositis After a Group C Streptococcal Toxic Shock Syndrome.

Pyomyositis is a bacterial infection deep within the muscles, often leading to multiple intramuscular abscesses. While historically linked with tropical regions, its incidence in temperate zones has been increasing, primarily due to factors such as immunosuppression. Typically, it manifests as a subacute infection, although when caused by Group C Streptococcus and resulting in toxic shock syndrome, it can lead to poorer outcomes. Here, we report a rare case of extensive multifocal bilateral pyomyositis in an immunocompetent young woman, preceded by toxic shock syndrome.

Navigating the Enigma of Pediatric Musculoskeletal Infections: A Race Against Time.

Musculoskeletal infection (MSKI) in children is a critical condition in pediatric orthopedics due to the potential for serious adverse outcomes, including multiorgan dysfunction syndrome, which can lead to death. The diagnosis and treatment of MSKI continue to evolve with advancements in infectious organisms, diagnostic technologies, and pharmacologic treatments. It is imperative for pediatric orthopedic surgeons and medical teams to remain up to date with the latest MSKI practices.

Changing spectrum of primary pyomyositis in North India.

Recent data have demonstrated the changing epidemiology of primary pyomyositis worldwide. Our hospital-based retrospective study investigated the clinical and microbiological spectrum of primary pyomyositis between 2013 and 2021 in PGIMER (Chandigarh), India. Over a quarter had predisposing conditions, mainly diabetes mellitus and immunosuppressive therapy. Fever, muscle pain, local swelling and breathlessness were the usual presentations, with quadriceps, iliopsoas and gluteal muscles commonly affected. Staphylococcus aureus was the predominant cause, with c.50% methicillin-resistant strains. Almost two-thirds presented with metastatic infection (stage 3 pyomyositis), frequently with septic lung emboli. Patients with methicillin-sensitive and resistant Staphylococcus aureus had a similar incidence of metastatic infection. In-hospital mortality was c.10% and was strongly associated with a high international normalised ratio. Primary pyomyositis remains a significant problem, with a dramatic increase in community-associated methicillin-resistant Staphylococcus aureus.

Piomiositis multifocal por Staphylococcus aureus. A propósito de un caso pediátrico

Introducción: la piomiositis (PMS) es una infección bacteriana aguda o subaguda del músculo esquelético. Entidad rara en pediatría, suele acompañarse de la formación de abscesos. Se presenta más frecuentemente en preescolares de sexo masculino, afectando mayoritariamente a extremidades y región pélvica. La manifestación multifocal es frecuente. El principal agente etiológico es Staphylococcus aureus. Caso clínico: 3 años, sexo masculino, sano. Consulta por fiebre continua de hasta 39 ºC de seis días de evolución, dolor de ambos miembros inferiores a predominio izquierdo, cojera y repercusión general. Examen físico: tumoración en muslo izquierdo de límites difusos de 13 x 5 cm, lisa, firme, impresiona adherida a planos musculares, dolorosa. Sin elementos fluxivos en la piel. Ecografía de partes blandas: aumento de tejidos blandos de la extremidad. Resonancia magnética (RM): abscesos que comprometen logia de los aductores del miembro izquierdo, el vasto externo del muslo derecho, musculatura paravertebral lumbar izquierda y cérvico-torácica izquierda. Tratamiento: drenaje, requiere de múltiples limpiezas quirúrgicas y antibioticoterapia prolongada. Cultivo de la lesión: Staphylococcus aureus meticilino resistente (SAMR). Buena evolución clínica e imagenológica. Discusión: la PMS ha presentado una incidencia creciente con la aparición del SAMR. La ecografía es un método adecuado para realizar diagnóstico local. La experiencia en la interpretación de la RM permite pesquisar el compromiso multifocal, identificando focos sin traducción clínica. La antibioticoterapia y el drenaje quirúrgico son los pilares del tratamiento. El pronóstico es bueno en la mayoría de los casos.

Summary: Introduction: pyomyositis (PMS) is an acute or subacute bacterial infection of the skeletal muscle. It is a rare infection in pediatrics, and it is usually accompanied by abscess formation. It occurs more frequently in male preschoolers, mostly affecting the extremities and pelvic region. The multifocal manifestation is frequent. The main etiological agent is Staphylococcus aureus. Clinical case: 3 year-old, male, healthy patient. He consulted for continuous fever of up to 39ºC of 6 days of evolution, pain in both lower limbs predominantly on the left, lameness and general repercussions. Physical examination: a 13 x 5 cm tumor in the left thigh with diffuse limits, smooth, firm, adhered to muscle layers, painful. Without fluxive elements on the skin. Soft tissue ultrasound: enlargement of the soft tissues of the extremity. Magnetic resonance imaging (MRI): abscesses involving the adductor lodge of the left limb, the vastus lateralis of the right thigh, left lumbar paravertebral musculature and left cervical-thoracic musculature. Treatment: drainage, requires multiple surgical cleanings and prolonged antibiotic therapy. Culture of the lesion: methicillin-resistant Staphylococcus Aureus (MRSA). Good clinical and imaging evolution. Discussion: PMS has had an increasing incidence with the appearance of MRSA. Ultrasound is a suitable method for local diagnosis. Experience in the interpretation of MRI has enabled us to research multifocal involvement, identifying unobserved foci during clinical check-up. Antibiotic therapy and surgical drainage are the main treatments. The prognosis is good in most cases.

Introdução: Ia Piomiosite (TPM) é uma infecção bacteriana aguda ou subaguda do músculo esquelético. É uma entidade rara em pediatria, costuma vir acompanhada de formação de abscessos. Ocorre com maior frequência em pré-escolares do sexo masculino, afetando principalmente as extremidades e a região pélvica. A manifestação multifocal é comum. O principal agente etiológico é o Staphylococcus aureus. Caso clínico: paciente 3 anos, sexo masculino, hígido. Consulta por febre contínua de até 39ºC há 6 dias, dor em ambos os membros inferiores predominantemente esquerdo, claudicação e repercussão geral. Exame físico: tumor na coxa esquerda com limites difusos de 13 x 5 cm, liso, firme, aparentemente aderido aos planos musculares, doloroso. Sem elementos fluidos na pele. Ultrassonografia de tecidos moles: aumento dos tecidos moles da extremidade. Ressonância magnética (RM): abscessos envolvendo o alojamento adutor do membro esquerdo, vasto lateral da coxa direita, músculos paravertebrais lombares esquerdos e cérvico-torácicos esquerdos. Tratamento: drenagem, requer múltiplas limpezas cirúrgicas e antibioticoterapia prolongada. Cultura da lesão: Staphylococcus aureus resistente à meticilina (MRSA). Boa evolução clínica e imagiológica. Discussão: a TPM tem tido uma incidência crescente com o aparecimento do MRSA. A ultrassonografia é um método adequado para diagnóstico local. A experiência na interpretação de ressonância magnética permite-nos investigar o envolvimento multifocal, identificando focos sem tradução clínica. A antibioticoterapia e a drenagem cirúrgica são os pilares do tratamento. O prognóstico é bom na maioria dos casos.

Hip Pain and Fever During a Nadir Period: Who Came First?

Pyomyositis is a rare bacterial infection of the skeletal muscle that often presents with insidious symptoms, thus making the diagnosis challenging. It is categorized into primary and secondary (usually traumatic) variants, mainly occurring in tropical regions and occasionally in temperate climates, with predisposing factors including immunosuppression. Staphylococcus aureus is the most common pathogen. A 39-year-old woman with a history of breast cancer underwent a mastectomy followed by chemotherapy. After her second chemotherapy cycle, she developed fever, odynophagia, vomiting, and right hip pain (considered to be related to muscle tension due to functional exercises). Fever and hip pain progressively worsened and the other symptoms resolved. On the 12th day after chemotherapy, she received intramuscular diclofenac injections due to severe hip pain. Physical examination revealed tenderness in her right hip and signs of inflammation on her thigh and buttock. Laboratory tests showed elevation of inflammatory markers and mild kidney and liver dysfunction. A CT scan revealed an intramuscular collection in her right gluteal region (~45 x 70 mm), with adjacent fat densification. Attempts to drain the collection initially failed, but a later ultrasound-guided procedure was successful and pus was collected for bacterial culture, which identified methicillin-susceptible Staphylococcus aureus (MSSA). Antibiotic treatment was adjusted to target SA with flucloxacillin and the patient's condition improved. Subsequent imaging showed a resolving collection (<10 mm). The patient continued antibiotic treatment for six weeks, maintaining clinical improvement, normal inflammatory parameters, and apyrexia. Adjuvant chemotherapy was discontinued due to the risk of infection recurrence associated with the multiloculated collection caused by SA. The patient remained asymptomatic four months after hospitalization. An MRI then showed only a residual T2 hyperintensity in the deeper region of the right buttock, with no visible collections. The nadir period refers to the time after each chemotherapy cycle when the risk of neutropenia and subsequent infection is the highest, typically occurring between 7 and 14 days after each cycle. In this case, the intramuscular injection occurred 12 days after the second cycle of chemotherapy. It is most likely that this served as the entry point for the pyomyositis agent (MSSA) during a period of transient neutropenia.

Wheel of misfortune: A unique case of MRSA pyomyositis of the adductor muscle group from blunt unicycle trauma.

In patients with infectious symptoms and severe muscle pain, it is crucial to consider pyomyositis as a significant potential cause. A normal complete blood count should not exclude this possibility early in the course. Early advanced imaging modalities and blood cultures are crucial in narrowing the differential. Methicillin resistant Staphylococcus aureus is increasingly implicated.

A prospective study on skin and soft tissue infections: a fact-finding mission from a tertiary centre in north India.

OBJECTIVE: Despite the high prevalence and poor outcome of skin and soft tissue infections (SSTIs), very few studies from India have dealt with the subject. We planned a prospective study of inpatients with SSTIs to study the aetiology, clinical presentation (severity) and outcome of patients with SSTIs in our facility. METHOD: Patients with SSTIs involving >5% body surface area (BSA) and/or systemic signs were admitted to the surgery department of a teaching tertiary level hospital in Delhi, India, and were clinically classified into cellulitis, necrotising soft tissue infections (NSTIs), pyomyositis, and abscess. Demographic and clinical variables such as: age; sex; occupation; history of trauma/insect or animal bites; duration of illness; presenting symptoms and signs; comorbid conditions; predisposing factors such as lymphoedema or venous disease; hospital course; treatment instituted; complications; hospital outcome; presence of crepitus, bullae, gangrene, muscle necrosis and compartment syndrome were recorded. The chief outcome parameters were death and length of hospital stay; others, such as abscess drainage, the need for plastic surgical procedures and amputations were also noted. RESULTS: Out of 250 patients enrolled in the study, 145 (58%) had NSTIs, 64 (26%) had abscesses, 15 (6%) had cellulitis and 26 (10%) had pyomyositis. Mortality was observed with NSTIs (27/145, 19%) and with pyomyositis (3/26, 11.5%). Factors affecting mortality by univariate analysis in the NSTI group were: abnormal pulse; hypotension; tachypnea; bullae; increased blood urea and serum creatinine; inotrope or ventilator support (all with p<0.001); local tenderness, gangrene, dialysis support and BSA (9.33±6.44 versus 5.12±3.62; p<0.05 for the last four). No factor was found to be significant on multivariate analysis. Variables associated with hospital stay >12 days were immunocompromise, pus discharge, ulceration or gangrene, and after interventions such as blood transfusion, drainage or skin grafting. CONCLUSION: High prevalence of NSTI and pyomyositis with high mortality was observed in our SSTI patients, often in immunocompetent young individuals. Epidemiological studies focused on virulent strains of Staphylococcus aureus may be required to identify the cause, since Staphylococcal toxins have been implicated in other infections.