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.     

An unusual case of Streptococcus anginosus group pyomyositis diagnosed using direct 16S ribosomal DNA sequencing

Bacteria belonging to the Streptococcus anginosus group (Streptococcus intermedius, Streptococcus constellatus and Streptococcus anginosus) are capable of causing serious pyogenic infections, with a tendency for abscess formation. The present article reports a case of S anginosus group pyomyositis in a 47-year-old man. The pathogen was recovered from one of two blood cultures obtained from the patient, but speciation was initially not performed because the organism was considered to be a contaminant (viridans streptococci group). The diagnosis was ultimately confirmed using 16S ribosomal DNA sequencing of purulent fluid obtained from a muscle abscess aspirate. The present case serves to emphasize that finding even a single positive blood culture of an organism belonging to the S anginosus group should prompt careful evaluation of the patient for a pyogenic focus of infection. It also highlights the potential utility of 16S ribosomal DNA amplification and sequencing in direct pathogen detection from aspirated fluid in cases of pyomyositis in which antimicrobial therapy was initiated before specimen collection.     

Pyomyosite des adducteurs à Escherichia coli chez une femme immunocompétente,en zone tempérée

Pyomyositis is a primitive infection of the skeletal muscle usually caused by Staphylococcus aureus in tropical areas, and associated with immunodeficiency. We report a 49-year-old immunocompetent woman, living in a temperate climate presenting with a pyomyositis of adductor muscles caused by Escherichia coli. Diagnosis was obtained with magnetic resonance imaging (MRI). Disease course was uneventful after surgical debridement and antibiotics. This case report highlights the usefulness of MRI in the diagnosis of pyomyositis.     

Gram-negative bacterial pyomyositis: unique case and review

Bacterial pyomyositis in tropical or temperate climates is usually associated with gram-positive organisms, and Staphylococcus aureus has been recovered most often. In contrast, skeletal muscle infection due to aerobic gram-negative bacteria is an acknowledged rarity, even in tropical areas. A literature review revealed only five organisms implicated in gram-negative pyomyositis in the United States; to this list, we add a unique case of pyomyositis caused by Serratia marcescens that occurred in a patient with multiple myeloma. Although the data are limited, it appears that lower leg muscles are more likely to be involved and that clinical cure is often achieved following appropriate drainage and antibiotic therapy.     

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.     

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 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.     

Bacterial pyomyositis in the United States

The incidence of reported bacterial pyomyositis is increasing in the United States, especially among immunocompromised persons. This review summarizes all reported cases of pyomyositis among human immunodeficiency virus (HIV)-infected persons worldwide and HIV-negative persons in the United States since 1981. During the era of combination antiretroviral therapy, bacterial pyomyositis among HIV-infected persons typically occurred in those with end-stage acquired immunodeficiency syndrome. Among non-HIV-infected patients, about half have a serious underlying medical problem, most commonly diabetes mellitus, malignancy, or a rheumatologic condition. These patients are more likely to have a gram-negative infection, a normal white blood cell count, multifocal involvement, or higher mortality than those without an underlying medical condition. The characteristics of cases in temperate areas are similar to tropical cases, except that the former occurs more often in immunocompromised persons; this may change with the HIV epidemic in tropical regions.     

Pyomyositis and polyarticular septic arthritis from Hemophilus influenzae in a nonimmunocompromised adult

We describe a healthy woman in whom pyomyositis of the left buttock, polyarticular septic arthritis, and meningitis due to Hemophilus influenzae type B developed after pneumonia. Systemic antibiotic therapy and local drainage provided a good result. This is the first case of pyomyositis and the 30th case of septic arthritis from Hemophilus influenzae described in an adult.     

Pyomyositis associated with hematological malignancy: case report and review of the literature.

Pyomyositis occurs most commonly in patients with various immunosuppressive diseases. However, the association of pyomyositis with an underlying hematological malignancy has not been reviewed. We present herein a relevant case and also review the available literature regarding the association of non-tropical pyomyositis and hematological malignancies. The case patient, a 46-year old female, had non-tropical pyomyositis of the iliopsoas and obturator muscles due to Staphylococcus aureus and underlying Hodgkin's disease. Forty-four patients with pyomyositis and an associated hematological malignant disease have been reported in the literature. The most common types of hematological oncology diseases found were acute lymphocytic leukemia (present in 11/44 patients (25%)) and multiple myeloma (7/44 patients (15.9%)). Staphylococcus aureus was the most common cause of pyomyositis (26 out of 44 patients (59.1%)). The muscles of the thigh were most commonly affected (18/44 patients (40.9%)). Medical therapy with antibiotics and surgical drainage were employed in 25/44 (56.8%) of the patients. Thirty out of 44 (68.2%) of the patients had a successful outcome. Death occurred in 5/44 (11.4%) patients. In cases of pyomyositis, the physician should consider an underlying hematological malignancy.     

Nontropical pyomyositis as a cause of subacute, multifocal myalgia in the acquired immunodeficiency syndrome

We report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated Mycobacterium avium infection, in which severe myalgia was the presenting symptom over several weeks. Multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques. The epidemiology, possible pathogenesis, clinical features, diagnostic imaging, and therapy are reviewed. Early suspicion of nontropical pyomyositis in severely immunocompromised patients with "cryptic" myalgia is recommended.     

Pyomyositis: Tropical disease in a temperate climate

Two cases of pyomyositis or bacterial abscess of striated muscle in adults are presented. One patient was initially diagnosed as having acute thrombophlebitis of the lower extremity. Computerized tomography was helpful in establishing the correct diagnosis. The other patient presented with a closed compartment syndrome following blunt trauma. Both patients responded to open drainage and antibiotic therapy, although the diagnosis was delayed for over three weeks in one patient. Although common in the tropics, pyomyositis is unusual in the temperate zone. Unfamiliarity with this entity remains the major obstacle to appropriate management.     

Pyomyositis and hepatic abscess in association with Aeromonas hydrophila sepsis

This report describes a patient with chronic liver disease in whom Aeromonas hydrophila sepsis developed following ingestion of fresh lake water. A hepatic abscess and bilateral calf pyomyositis, an extremely rare and previously fatal complication of A. hydrophila septicemia, subsequently developed. The patient recovered following bilateral fasciotomies and systemic antibiotic therapy with gentamicin and trimethoprim/sulfamethoxazole. No previous survivors of A. hydrophila pyomyositis secondary to metastatic infection have been described. A discussion of these rare sequelae of A. hydrophila septicemia and their effective management is included.     

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.     

Primary pyomyositis and disseminated septic pulmonary emboli: a reactivated staphylococcal infection?

Staphylococcal pyomyositis is a severe invasive soft tissue infection with high mortality rate that is increasingly being recognized even in temperate climates. In most cases predisposing factors are identified that include either source of skin penetration or/and impaired host immunocompetence. A case of primary, community-acquired pyomyositis of the left iliopsoas muscle in a 59-year-old immunecompetent woman, which was complicated with septic pulmonary emboli within 24 h after hospital admission, is presented. The patient was subjected to abscess drainage under computed tomography guidance. Both pus aspiration and blood cultures revealed methicillin-susceptible Staphylococcus aureus. Given the absolute absence of predisposing factors and a remote history of staphylococcal osteomyelitis in the same anatomical region 53 years ago, reactivation of a staphylococcal soft tissue infection was postulated. Systematic review of the literature revealed a few interesting cases of reactivated staphylococcal infection after decades of latency, although the exact pathophysiological mechanisms still need to be elucidated.     

Extensive pyomyositis secondary to paronychia-related MRSA infection: A case report

Rationale:Pyomyositis is characterized by an insidious and multifactorial inflammatory process, which is often caused by hematogenous pathogen. Predisposing risk factors include immunodeficiency, diabetes, malignancy, or trauma. The spectrum of clinical presentation depends on disease severity, typically presented by fever and hip pain. We hereby present a case with extensive pyomyositis secondary to chronic paronychia infection.Patient concerns:A 14-year-old immunocompetent male presented with fever and hip pain. The patient was initially surveyed for common infectious etiologies prior to the presentation of acute limping, which led to image confirmation of extensive pyomyositis.Diagnosis:The patient presented with acute pain in the right hip accompanied by headache, myalgia of the right leg, and intermittent fever for a week. Physical examination disclosed limping gait, limited range of motion marked by restricted right hip flexion and right knee extension, and chronic paronychia with a nail correction brace of the left hallux. Diagnosis of pyomyositis was confirmed by magnetic resonance image. Methicillin-resistant strains of Staphylococcus aureus was isolated from the patient''s blood and urine cultures within 2 days of collection. The same strain was also isolated from the pus culture collected via sonography-guided aspiration.Interventions:Antibiotics treatment with oxacillin, teicoplanin, daptomycin, and fosfomycin were administered. Sonography-guided aspiration and computed tomography-guided pigtail drainage were arranged, along with nail extraction of his left hallux paronychia prior to discharge. Oral antibiotics fusidic acid was prescribed. Total antibiotics course of treatment was 4 weeks.Outcomes:The patient gradually defervesced and was afebrile after drainage. Followed limb doppler sonography showed regression of the abscess at his right lower limb. Gait and range of motion gradually recovered without sequelae.Lessons:Ambulation and quality of life are greatly affected by the inflammatory process of pyomyositis. Detailed evaluation of predisposing factors should be done, even in immunocompetent individuals. Timely diagnosis is vital to successful treatment.     

Antiretroviral therapy for treatment-naïve chronic HIV-1 infection with an axonal variant of Guillain-Barré syndrome positive for anti-ganglioside antibody: a case report

Guillain-Barré syndrome sometimes manifests as immune reconstitution inflammatory syndrome. We report a treatment-na?ve male with chronic HIV-1 infection who presented with an axonal variant of Guillain-Barré syndrome. Antiretroviral therapy commenced one month later and no rapid improvement or deterioration of tetraparesis was noted. This is the first report that describes the detection and serial measurements of anti-ganglioside antibody in a patient with HIV infection. This case suggests a limited role for T-cell immunity in the production of anti-ganglioside antibody and the pathogenesis of axonal variants, since the antiretroviral therapy-induced improvement in T-cell immunity neither re-elevated anti-ganglioside antibody titer nor worsened tetraparesis.     

High HIV seroprevalence among patients with pyomyositis in Northern Uganda

With the aim of correlating pyomyositis with HIV infection, we have carried out a case-control comparison of HIV seroprevalence among patients affected by pyomyositis and an age and sex-matched control group of healthy subjects. Over a one-year period, 35 patients with pyomyositis, 20 male and 15 female, mean age 28.31 years, were admitted to Dr Ambrosoli Memorial Hospital of Kalongo (Kitgum District, Northern Uganda). Among these patients, II were HIV-antibody-positive, with a seroprevalence of 31.42%. In the age and sex-matched control group of 35 healthy subjects, selected in the same period from volunteers admitted to the surgical ward for orthopaedic trauma, two were HIV-antibody-positive, with a seroprevalence of 5.71%. The matched analysis produced a Mantel-Haenszel matched odds ratio of 5.50 and a maximum likelihood estimate of OR (MLE) of 5.50 (exact 95% confidence limits for MLE=1.20P<0.0001). The authors conclude that pyomyositis is a bacterial infection very significantly associated with HIV infection, to be considered a strong sign of stage III–IV of HIV disease.     

Pneumococcal pyomyositis: report of 2 cases and review of the literature

Streptococcus pneumoniae is an uncommon cause of pyomyositis. It is unclear whether the clinical presentation and outcome of pneumococcal pyomyositis differ depending on the host's underlying immune status. We describe 2 patients with pneumococcal pyomyositis, review all published cases, and compare characteristics between apparently healthy hosts and at-risk hosts. A total of 35 cases of pneumococcal pyomyositis were identified, 11 in apparently healthy hosts and 24 in at-risk hosts. Two-thirds of the patients had an antecedent respiratory illness or meningitis. At-risk hosts tended to have a longer interval between the development of symptomatic muscle infection and the diagnosis of pyomyositis and a significantly higher risk of disseminated disease at presentation, as manifested by involvement of multiple noncontiguous muscles or presence of meningitis. Overall, other than 1 death, all patients recovered with antibiotics and surgical drainage, but as might be expected there was a significantly higher rate of complications among at-risk hosts.     

Tropical pyomyositis presenting as sepsis with acute respiratory distress syndrome

Tropical pyomyositis is an underdiagnosed condition. We reported a 35 year old male farmer, who presented with septicemia and acute respiratory distress syndrome due to pyomyositis involving the paraspinal muscles. Culture of the pus grew methicillin sensitive Staphylococcus aureus, and the patient recovered after surgical drainage and antibiotic treatment. Diagnostic delays can be avoided if tropical pyomyositis is considered as a differential diagnosis in patients with septicemia.