Tropical pyomyositis in a Greek adult

A case of tropical pyomyositis in a 24-year-old Greek is reported. The patient presented with high fever and swelling of the left thigh, generalized lymphadenopathy and multiple infiltrations in both lung fields on X-ray of the chest. Multifocal muscle abscesses were detected by CT scan of the left thigh and gluteal area. Staphylococcus aureus was identified in cultures of the purulent material which was surgically drained. The patient was subsequently treated with appropriate antibiotics. Lack of familiarity with this disease caused diagnostic confusion and delayed the initiation of treatment.     

Multilocalized pyomyositis in a previously healthy subject.

A case of pyomyositis is presented. This case is unique in the literature as at least 29 abscesses were detected, affecting the vast majority of big muscle groups. We outline the origin of this disease entity which selectively affects striated muscles. We also discuss its natural history and management strategy.     

An uncommon spontaneous and nontropical pyomyositis

We describe a case of pyomyositis of the thigh caused by Staphylococcus epidermidis in an immunocompetent patient. The outcome was favorable after initiation of treatment combining surgical debridement of muscle abscesses and appropriate antibiotic therapy for a 4-week period. Our case report underlines that magnetic resonance imaging (MRI) may be a helpful method in the management of pyomyositis, in accurately revealing the detailed anatomic extent of the abscessed pyomyositis, and in guiding the surgical debridement of the damaged muscle. Finally, MRI should be performed if there is a strong suspicion of pyomyositis in patients whose ultrasonographic examination is not conclusive.     

Pyomyositis in patients with the human immunodeficiency virus: an unusual form of disseminated bacterial infection

PURPOSE AND PATIENTS: Pyomyositis, a common disease in the tropics, is rare in the continental United States, with approximately 83 cases described in the literature in the past two decades. The occurrence of pyomyositis complicating human immunodeficiency virus (HIV) infection has been reported in 10 patients since 1986. We report six cases of this entity in patients with advanced HIV disease seen in our institution over a 20-month period. A common denominator in all of our patients was muscle injury, induced by either exercise or trauma. Unlike most previous reports of HIV-associated pyomyositis, the clinical picture in our cases was complicated by the development of abscesses in multiple muscle groups, requiring prolonged antimicrobial therapy and repeated drainage procedures for successful management. Interestingly, one patient developed concomitant rhabdomyolysis--an otherwise rare event in classical pyomyositis. Staphylococcus aureus was the predominant infecting organism in this as well as all other series. Of note, we also observed and report the first case, to our knowledge, of gram-negative pyomyositis in an HIV-infected individual. The pathogenic implications of this catalase-producing gram-negative isolate are discussed in the context of neutrophil abnormalities in HIV disease. CONCLUSION: Like tropical pyomyositis, its HIV-associated counterpart appears to be multifactorial in origin. Its recent recognition suggests that, in addition to underlying abnormalities of host defense, factors relating to the prolonged survival of patients with late-stage disease, including myopathy, might play an important contributory role.     

A case of group B streptococcal pyomyositis

The group B streptococcus is an opportunistic pathogen that causes a variety of serious infections including bacteremias, puerperal sepsis, and neonatal meningitis. Group B streptococcal infections of muscle are rare. We report here an unusual case of group B streptococcal pyomyositis. Pyomyositis arises predominantly from infections caused by Staphylococcus aureus and, occasionally, Streptococcus pyogenes. Because of the rarity of pyomyositis in temperate climates, the common lack of localizing signs or symptoms, and the frequently negative blood cultures, considerable delay often precedes the diagnosis of pyomyositis; in fact, the infection has been initially misdiagnosed as muscle hematoma, cellulitis, thrombophlebitis, osteomyelitis, or neoplasm. Diagnosis may be greatly aided by radiologic techniques that can demonstrate the sites of muscle enlargement and the presence of fluid collections. The response to antibiotics is usually rapid, but resolution of the infection may require aspiration of deeply situated muscle abscesses. This report describes a diabetic patient with an unusual presentation of pyomyositis that mimicked an acute abdomen.     

Unklare Tetraparese unter Immunsuppression

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.     

Pyomyositis as a Focus of Infection in Hematological Disorders: A Report of 3 Cases

The cases of 3 patients with pyomyositis associated with hematological disorders are reported. A 40-year-old man in the blastic phase of chronic myelogenous leukemia and 2 men aged 46 and 71 years with neutropenia due to myelodysplastic syndromes all reported high fever and severe local myalgia and had marked elevation of C-reactive protein. Magnetic resonance imaging revealed muscle abscesses or fasciitis, and the findings led to the diagnosis of pyomyositis. Methicillin-resistant Staphylococcus aureus was isolated from the abscesses of 2 patients, and surgical drainage proved more effective than did antimicrobial agents. It should be recognized that pyomyositis is a possible source of infection in patients with hematological disorders.     

Disseminated paracoccidioidomycosis with peripleuritis in an AIDS patient

Paracoccidioidomycosis is one of the most frequent systemic and endemic mycoses of Latin America caused by a dimorphic fungus. In AIDS patients, paracoccidioidomycosis appears as a severe and disseminated disease with a wide spectrum of clinical findings. The CD4 counts are usually less than 200 cell/mu L. We present a case of disseminated paracoccidioidomycosis with peripleuritis and subcutaneous abscesses on the chest wall as initial manifestation of AIDS. In endemic countries, paracoccidioidomycosis should be included as an opportunistic infection in AIDS.     

Non-tropical thoraco-abdominal pyomyositis caused by group A streptococcus in an immunocompetent adult.

We present a case of group A streptococcal pyomyositis of the thoraco-abdominal wall of an immunocompetent adult. This diagnosis was made when soft tissue swelling was seen on chest X-ray. Complete recovery followed drainage of the collection and short-course i.v. penicillin. The importance, diagnosis and treatment of pyomyositis are outlined.     

Pyomyositis--with special reference to the comparison between extra- and intrapelvic muscle abscess

Fifteen patients, nine males and six females, diagnosed with pyomyositis from 1988 to 1994, and followed for an average of 69.8 months, were reviewed. Excluding two children, the average age was 56.6 years. Eleven adults (73.3%) had underlying diseases. The lesions were multiple in five patients (33.3%) and a total of twenty-four muscle abscesses, including eleven extrapelvic and thirteen intrapelvic, were identified. When comparing extra- and intrapelvic pyomyositis, intrapelvic pyomyositis presents a diagnostic challenge requiring a high index of suspicion. Distinct clinical features such as local heat and painful swelling were all identified in extrapelvic pyomyositis, but they rarely (in only two of the thirteen lesions) emerged in intrapelvic pyomyositis. The average time from presentation to diagnosis was significantly longer in intrapelvic than in extrapelvic pyomyositis (1.4 vs 9.7 days). Although aspiration showed a high diagnostic rate in extrapelvic muscle abscesses, it was difficult to perform and was occasionally misinterpreted in intrapelvic cases. Routine X-rays were not helpful in making the diagnosis. CT scan was valuable because it provided positive diagnostic findings in all twelve patients who received one. The causative organisms in our patients were Staphylococcus aureus in eight (53.3%), Escherichia coli in three (20%), and Klebsiella in three (20%). Treatments consisted of parenteral antibiotics for all patients, image-guided aspiration in four patients, and surgical drainage in eleven patients. Two intrapelvic pyomyositis patients expired due to sepsis. At the completion of the study, twelve patients were asymptomatic without sequel, and one patient had a recurrence.     

Case of disseminated pyomyositis in poorly controlled type 2 diabetes mellitus with diabetic ketoacidosis

Primary pyomyositis is a pyogenic and uncommon infection of skeletal muscle, which is mainly observed in tropical areas and/or human immunodeficiency virus patients. In non‐human immunodeficiency virus infected patients, the most common cause is diabetes mellitus. Because of its rarity, the accurate diagnosis is often challenging. Staphylococcus aureus is the most common causative bacteria. According to the severity, pyomyositis is divided into three stages, and the late stage is occasionally lethal. The present case was compatible with the most advanced stage. Therefore, it was very difficult to save her life without precise and timely diagnosis. Furthermore, in the invasive stage, surgical drainage and broad‐spectrum antibiotics should be given for a long enough period. Here, we report a case of a Japanese woman who developed disseminated abscesses under poorly controlled diabetic conditions accompanied by ketoacidosis, but was successfully treated without any sequelae.     

Citrobacter freundii: a newly reported cause of pyomyositis

Pyomyositis has been uncommonly reported in temperature climates, but is being recognized with increasing frequency. The most common etiologic agent is Staphylococcus aureus, although other pathogens have been rarely implicated. The authors describe the first case of pyomyositis caused by Citrobacter freundii. Because of the rarity of this disease in North America, it is often initially misdiagnosed. Neuromuscular sonography, a non-invasive imaging technique, identified the muscle abscess in this patient.     

Recurrent infection with Chromobacterium violaceum: first case report from South America

A case of chromobacteriosis in a young Brazilian with toxaemia and multiple skin abscesses is described. The infection responded to treatment with chloramphenicol and cotrimoxazole but recurred 18 months later following insect bites received while fishing in a river. Chromobacterium violaceum was subsequently isolated from the river water. This is the first case of this kind to be reported from South America.     

Pyomyositis with hepatic and perinephric abscesses caused by Candida albicans in a diabetic nephropathy patient

Both disseminated candidiasis and pyomyositis are rare and mainly encountered in severely immunocompromised hosts. To our knowledge, Candida albicans related pyomyositis with formation of multiple visceral abscesses in a diabetic nephropathy patient has never previously been reported. A 47-year-old man with diabetic nephropathy and alcoholic liver disease developed disseminated candidiasis, with the initial presentation of pyomyositis. Debridement was performed and intravenous fluconazole commenced. Despite development of a single hepatic and multiple perinephric abscesses, the patient made a full recovery after completion of a 12-week course of intravenous fluconazole therapy. Candida species should be considered a potential pathogen in patients with predisposing factors.     

Pyomyositis. Increasing recognition in temperate climates

Pyomyositis is common in the tropics yet is rarely reported in temperate climates. A woman in whom pyomyositis developed in a temperate climate is presented. Computed tomography was the key in the diagnosis of the disease involving the muscles of the left lateral chest wall. The patient's condition responded to intravenous antibiotics and open abscess drainage. The 31 cases reported in the United States are reviewed. Unfamiliarity still poses a barrier to early diagnosis, although pyomyositis is being more frequently described in temperate climates.     

Streptococcus pyomyositis occurring in a patient with dermatomyositis in a country with temperate climate.

We describe a man in whom pyomyositis developed in a temperate climate. Three facts make this case unique. First the pyomyositis developed in someone with underlying dermatomyositis, this being the second reported case to our knowledge. Second, the organism involved was a Streptococcus and not a Staphylococcus as in most cases described, and the course of the disease was acute and not subacute as is usually reported. Finally, contrary to most described cases, surgical drainage was not necessary, probably because of the early diagnosis. Pyomyositis should be considered a possible cause of localized pain in patients with underlying inflammatory muscle disease.     

Pyomyositis in North America: case reports and review.

We report two cases and review the characteristics of pyomyositis. The courses of patients who presented with pyomyositis at the Maricopa Medical Center (Phoenix) are detailed. Ninety-eight reported cases over the last 20 years in North America, found through a MEDLINE search, are summarized. Infection with the human immunodeficiency virus (HIV) may predispose the patient to pyomyositis. The onset is usually insidious with progression to large purulent collections and significant morbidity. The diagnosis is frequently suggested by findings of imaging studies. Staphylococcus aureus is responsible for most cases in tropical areas but is less frequently associated with cases in North America. Since infection with HIV predisposes patients to bacterial infections, pyomyositis will occur more frequently in this patient population. Increased awareness of the disease will improve management. Following aspiration or surgical drainage, therapy with broad-spectrum empirical antibiotics may be considered initially in the treatment of pyomyositis.     

MRSA pyomyositis complicating sickle cell anaemia.

A patient being treated for sickle cell crisis developed swollen, painful, indurated, discoloured thighs after several days in hospital. Imaging revealed the presence of multiple small abscesses in the muscle and methicillin resistant Staphylococcus aureus (MRSA) was cultured from aspirated fluid. Pyomyositis usually occurs in association with damaged muscle and impaired host defences. Staphylococcus is the most frequent organism involved. It is not a common complication of sickle cell disease, although it may be under diagnosed. Availability of advanced imaging techniques facilitates early diagnosis of pyomyositis.     

Pyogenic abscesses and parasitic diseases

Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi.     

MRSA pyomyositis complicating sickle cell anaemia

A patient being treated for sickle cell crisis developed swollen, painful, indurated, discoloured thighs after several days in hospital. Imaging revealed the presence of multiple small abscesses in the muscle and methicillin resistant Staphylococcus aureus (MRSA) was cultured from aspirated fluid. Pyomyositis usually occurs in association with damaged muscle and impaired host defences. Staphylococcus is the most frequent organism involved. It is not a common complication of sickle cell disease, although it may be under diagnosed. Availability of advanced imaging techniques facilitates early diagnosis of pyomyositis.