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.     

Multiple myeloma presenting with pyomyositis caused by community-acquired methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis>: report of a case and literature review

Pyomyositis is infrequently reported in patients with multiple myeloma. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important cause of soft tissue infections, including pyomyositis. Here, we report on the first case of CA-MRSA pyomyositis in a patient with multiple myeloma and review the relevant literature.     

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.     

A rare cause of focal myopathy in diabetes

Diabetic myonecrosis is a rare and under diagnosed complication of long standing diabetes. Its diagnosis requires high index of suspicion because the clinical features mimic with those of pyomyositis, deep vein thrombosis and muscle hematoma. MR imaging is the cornerstone for diagnosis of the condition and treatment is mainly conservative by giving rest to the affected limb and NSAIDs. We report a case of diabetic patient who developed this condition twice and was managed successfully both the times with analgesics alone because of timely diagnosis based on characteristic MRI findings.     

Solitary fibrous tumor in the thigh: review of the literature

Solitary fibrous tumors (SFT) of extremities, especially the thighs are very rare. Despite SFTs are generally benign, well-circumscribed soft tissue tumors new cases should be presented and followed up carefully to monitor their biological behavior. In general for tumor classification a biopsy is state of the art. Histological including immunohistochemical patterns for SFTs are defined. MRI and ultrasound are not sufficient for differential diagnosis. Once property identified and defined by size and location, resection with intact tumor capsule may result in full recovery of the patient. Reviewing the literature there are no validated reasons for a wider resection. The current patient was a 41-year-old male. Four years after an arthroscopy of the left knee the patient has been suffering an ongoing swelling of the lateral thigh. Because MRI scan data suggested a synovial sarcoma a biopsy was performed. The tumor was classified as a benign SFT. The diagnosis based on histological findings and the presence of the positive immunohistochemical markers Vimentin, CD34, and CD99. The complete tumor resection with intact capsule was achieved in a final operation. Clinical and in MRI after 54-month outcome period there were no local recurrences.     

Haemolytic Disease of the Newborn Due to Anti-G

Mrs P. presented at 13 weeks of gestation with apparent anti-C+D. At week 34, with antibody levels of 168 IU/ml, a D-negative (r′r) baby was delivered with a strongly positive DAT and an Hb of 3.0 g/dl. Anti-G in maternal serum was isolated by adsorption and elution from R₂R₂ cells and shown, using flow-cytometric and chemiluminescence assays, to sensitize r′r cells at levels of cell-bound IgG consistent with fetal haemolysis. In an analysis of 28 sera from alloimmunized women with over 5 IU/ml anti-C+D, 2 sera were shown to contain levels of anti-G consistent with moderate or severe haemolytic disease of the newborn (HDN). Thus HDN due to anti-G may not be rare. An analysis of 187,037 blood donors in the south-west of England showed the r′ gene frequency to be 0.005897 suggesting that approximately 2.9% of matings of rr women with D-negative fathers can produce an r′r baby. These findings highlight the need for the continuous non-invasive monitoring of D-negative fetuses of women with apparent anti-C+D.     

Hemolytic Disease of the Newborn Due to Anti-Leb

Abstract. A case of hemolytic disease of the newborn due to anti-Le^b is described. The mother possessed high titer IgG anti-Le^b reacting at 37°C and complement binding in nature. The infant had mild hemolytic disease with a positive direct Coombs' test using anti-IgG and anticomplement. Anti-Le^b could be eluted from the infant's red cells.     

Perforation of the Small Intestine Due to Eosinophilic Gastroenteritis

A 74-year-old woman with longstanding diarrhea and clinical symptoms of malabsorption and a raised peripheral eosinophilic count underwent an explorative laparotomy for small intestinal perforation. The resected specimen was consistent with the diagnosis of eosinophilic gastroenteritis. Despite corticosteroids, a second acute abdominal crisis occurred and the patient died. Small intestinal perforation due to transmural bowel wall involvement in eosinophilic gastroenteritis has to our knowledge not been described previously.     

An Example of Polyagglutinability Due to the Tn Antigen

S ummary . A case of atypical polyagglutinability due to the Tn antigen is described. The patient, although apparently healthy, has leucopenia and thrombocytopenia. Her cells presented the usual difficulties of polyagglutinable cells due to the presence of anti-Tn in typing reagents whether of human or animal origin. The practical advantages, particularly in ABO typing, of using papain to destroy the T and Tn receptors has been demonstrated. Anti-Tn, like anti-T, is a 19S and probably a γM globulin.
It has been clearly shown that Tn cells differ from T-activated polyagglutinable cells and Cad positive cells, but it has not been possible to convert normal cells to Tn cells. Certain aspects of both typical and atypical polyagglutinability have been discussed.     

Pyomyositis of the inner thigh muscles due to Escherichia coli in a young patient with severe aplastic anemia

Pyomyositis, an acute bacterial infection of skeletal muscle, is caused by Staphylococcus aureus or other gram-positive organisms in >90% of cases. A 19-year-old boy with severe idiopathic aplastic anemia presented a pyomyositis of inner thigh muscles due to Escherichia coli as a complication of his underlying disease. The diagnosis was established by means of soft tissue ultrasound, magnetic resonance imaging (MRI) and blood culture. Surgical debridement and antibiotic treatment were performed. Postoperative course was uneventful and pyomyositis was successfully resolved. Pyomyositis caused by E. coli is uncommon condition, and very few cases have been reported, most of them being severe immunodeficiency patients, but we should know the existence of this entity and its management.     

Ulceration and Necrosis of the Tongue Due to Giant Cell Arteritis

ABSTRACT A case is reported of giant cell arteritis in a 74-year-old woman, complicated by ulceration and necrosis of the tongue. During steroid treatment recovery was observed.