Vesicoureteral reflux in a boy presenting with difficulty in walking

BACKGROUND: We report an uncommon case who presented himself at our hospital with main complaints of high fever and difficulty in walking due to pain on extension of his right lower extremity. METHODS: He was diagnosed, through investigation of his urinary tract, as having secondary psoas pyomyositis spread from acute pyelonephritis caused by vesicoureteral reflux. RESULTS: He was successfully managed firstly by antibiotic therapy, followed by the correction of reflux by ureteroneovesicostomy.     

Primary obturator pyomyositis

BACKGROUND: The main objective of our work was to draw attention to the possible occurrence of a serious and life-threatening illness, primary pyomyositis of the obturator muscles in countries with a mild climate, and to establish basic diagnostic criteria for the illness, including differential diagnostics, and to propose a treatment method. METHODS: The authors describe two cases (a boy of 11 and a woman aged 47 years) with the occurrence of primary pyomyositis of the obturator muscles in the Czech Republic and they focus on the most important clinical symptoms and imaging methods necessary for the establishment of the diagnosis. RESULTS: Repeated clinical examinations are important for the establishment of the diagnosis, particularly the presence of the symptom triad (pain in the hip joint, limping, febrile state), positive inflammatory markers and, first and foremost, the demonstration of pyomyositis on CT or MR. Differential diagnosis must also consider inflammatory diseases of the locomotor system (coxitis, sacroiliitis, osteomyelitis), of the digestive tract (Crohn's disease, a tumour, an obturator hernia) and of the urogenital system (gonorrhoea). CONCLUSION: The therapy of pyomyositis must be initiated in time by bed rest and administration of antibiotics and, if an abscess develops, surgical intervention is unconditionally necessary, consisting either in percutaneous abscess puncture or incision, perfusion, and application of antibiotics. The failure to diagnose an abscess of the obturator muscles and late therapy can result in serious complications, septic shock and death.     

Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.     

Bifocal pyomyositis in a 3-year-old child with eczema: a case report

Pyomyositis is an infection of the skeletal muscles, resulting in a pus-filled abscess. Immunodeficiency of the patient is considered to play an important role in pathogenesis. We report a case of a 3-year-old child, who presented with multifocal pyomyositis in the gastrocnemius muscle, extending to the posterior muscles of the thigh. Even though there was no evidence of immunodeficiency, the presence of atopic eczema in the big toe of the affected limb could interfere with the immune system response, and therefore, could be associated with pyomyositis. The increasing incidence of pyomyositis in non-tropical areas and its severe complications requires an acute clinical awareness.     

Necrotizing fasciitis of the lower limb after venous surgery: cases studies and a review of the literature

We report 2 cases of necrotizing fasciitis following stripping of the long saphenous vein and phlebectomy of varicose collateral vessels. The first one concerns a 42-year-old man who presented with a left thigh postoperative infection, evolving despite oral antibiotic therapy. Urgent surgical exploration proved an extensive necrosis consistent with necrotizing fasciitis. Wide excision of the necrotic tissue was performed. Under intravenous antibiotic therapy, local wound care and hyperbaric oxygen therapy, the patient's condition improved. The second case concerns a 60-year-old man with cardio-vascular disease and diabetes. He was transferred in our institution 7 days after surgery for an infection in the right thigh and septic shock. Immediate surgical exploration showed extensive necrotizing fasciitis of the thigh, popliteal fossa and latero-posterior compartments of the leg. Muscle necrosis of the right leg was also observed. A right supra-condylar amputation was performed. The patient improved under antibiotherapy and hyperbaric oxygen therapy.     

Acromioclavicular Septic Arthritis and Sternoclavicular Septic Arthritis with Contiguous Pyomyositis

Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.     

Pancarditis: a rare complication of tropical pyomyositis

Tropical pyomyositis is a bacterial infection of the skeletal muscles leading to abscess formation, occurring in the tropical areas, often following minor trauma. We report a case of pancarditis as the direct complication of pyomyositis in a 10-year-old girl who presented with painful swelling of her right thigh, high grade fever and impaired consciousness. Echocardiography showed pericardial effusion with strands and a large vegetation in the left ventricle cavity. She was treated successfully with open heart surgical drainage and intravenous antibiotics. We emphasize early diagnosis and prompt treatment of pyomyositis to reduce its associated mortality and morbidities.     

The gift that keeps on giving

Case 1: A 39-year-old man with chronic lower extremity lymphedema was admitted to the hospital with acute fever, chills, and left lower extremity pain, swelling, and erythema for the third time in as many months. Examination revealed a temperature of 39 degrees C (102.2 degrees F), and erythmatous induration on the left leg (Figure). The patient was treated with IV clindamycin and cefazolin, with clinical improvement. He was discharged with azithromycin, 500 mg daily for 3 days, done twice monthly. Case 2: A 52-year-old morbidly obese man with stasis dermatitis presented with acute lower extremity pain, swelling, and associated fever. He had been taking prophylactic antibiotics for his recurrent cellulitis for more than a decade and had significantly decreased his number of reoccurrences while on this therapy. He was admitted to the hospital, treated with IV cefazolin, and had a rapid improvement over 48 hours. He was subsequently discharged with continued suppressive antibiotic therapy.     

经皮肾镜术后感染性休克一例报告并文献复习

目的探讨经皮肾镜术后感染性休克的防治。方法报告1例62岁女性双肾结石并左肾积水，尿培养发现细菌，术前给予3d抗感染治疗后，行左侧经皮肾镜钬激光碎石术后出现感染性休克，结合文献对经皮肾镜术后出现感染性休克的防治进行复习。结果术中行大通道经皮。肾镜钬激光碎石，手术时间105min。术后12h开始出现血压下降，体温升高，血白细胞升高。经抗感染补液扩容等治疗后治愈出院。结论术前给予充分抗感染治疗，术中灌洗保持低压，术后密切监测生命体征和神志变化并加强抗感染治疗，可有效防治经皮。肾镜术后感染性休克的发生。     

Metastatic tumor of the epididymis from pancreatic carcinoma: a case report]

A 58-year-old male who complained of painful left scrotal swelling consulted a local clinic in August 1998. Because his symptoms did not improve after antibiotic therapy, he was transferred and admitted to Jyouhoku City Hospital on September 14, 1998. Pelvic computed tomography (CT) was performed, and revealed left epididymitis. However, antibiotic treatment did not improve the condition. Then, because carcinoma of the epididymis was suspected, left inguinal orchiectomy was performed. We found a tumor in the spermatic cord and another tumor in the epididymis. The pathological diagnosis was adenocarcinoma, and metastatic carcinoma from the digestive tract was suspected. Therefore, examinations were performed to detect the primary cancer. CT and magnetic resonance imaging (MRI) demonstrated an invasive irregular tumor from the pancreas to the left kidney. Irregular mucosa was observed by gastrointestinal fiberscopy. A biopsy was performed and the pathological diagnosis was adenocarcinoma. Based on these findings, the patient was diagnosed as having a metastatic tumor of the epididymis and spermatic cord caused by pancreatic carcinoma. This is the 3rd case of adenocarcinoma of the pancreas that presented as an epididymal nodule, and this is the 12th case of adenocarcinoma of the pancreas that presented as a spermatic cord nodule.     

Renal abscess in childhood

Eight patients with renal abscess were seen in a 15-year period. The patients' ages ranged from 3 to 15 years with a mean of 6.5 years. Included were 7 female children, five of whom were Aboriginal, and 1 male child. Clinical presentation ranged from localized renal symptoms to a generalized septicaemic illness. Ultrasonography proved to be the most useful diagnostic investigation. Surgical management consisted of open surgical drainage in 5 cases with secondary nephrectomy in one. Two recent cases were managed by percutaneous drainage of the abscess together with appropriate antibiotic therapy. One case was successfully managed by antibiotic therapy without surgical or radiological intervention. In 5 cases the infecting organism was penicillinase-producing Staphylococcus aureus and, in 2 cases, Escherichia coli was isolated. It is concluded that the diagnosis of renal abscess should be considered in patients with a febrile septicaemic illness, particularly in Aboriginal female children. Ultrasonography is recommended as the investigation of choice which can also be used to establish percutaneous drainage, thus avoiding surgery.     

Successful management of a ruptured infected aneurysm of the thoracic aorta: report of a case

A successful removal of the infected thoracic aortic aneurysm ruptured to the lung is reported. A 59-year-old man who had been suffering from high fever showed sudden hemoptysis and shock during antibiotic therapy. Immediately a so-called temporary bypass grafting from ascending aorta to descending aorta was placed with a woven Dacron prosthesis, and then aneurysmectomy with upper lobectomy of the left lung was carried out. Finally the graft was left as a permanent bypass graft. In addition, the left subclavian artery was reconstructed with a EPTFE graft. The patient is now well one year after operation.     

Pyomyositis in children: early diagnosis and treatment

Purpose

This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis.

Methods

Between 2001 and 2006, 6 children with a mean age of 7.2 years were diagnosed and treated for pyomyositis in our clinic. The most common site of involvement was the hip and thigh region. All patients underwent early magnetic resonance imaging (MRI) examination that played a significant role in the early diagnosis and management of the disease.

Results

Staphylococcus aureus was the most common pathogen and was identified in 3 cases. Intravenous antibiotics were administered and were followed by oral agents for an additional period. The duration of therapy ranged from 3 to 6 weeks. No surgical intervention was needed. Magnetic resonance imaging was used to evaluate response to the therapy.

Conclusions

Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis.     

Pyomyositis in a 69-year-old tennis player

Pyomyositis is an acute bacterial infection of skeletal muscle usually caused by Staphylococcus aureus. Outside of tropical areas, pyomyositis is rare, especially in an otherwise healthy individual. We present a case of a 69-year-old tennis professional who developed pyomyositis of the piriformis muscle following a tennis tournament. We discuss the literature on pyomyositis and the need for high clinical suspicion in the diagnosis of this disorder, as well as the need for early aggressive antibiotic treatment.     

Pyomyositis in an HIV-positive premature infant: case report and review of the literature

Pyomyositis is a purulent infection of skeletal muscle caused predominantly by Staphylococcus aureus. Although not often encountered in the continental United States, pyomyositis is frequently seen in tropical areas. Pyomyositis is difficult to diagnose as it may mimic other diseases. Delay in diagnosis may lead to septicemia, shock, and death. Recently, two cases of patients with pyomyositis and acquired immune deficiency syndrome were reported. We report a case of pyomyositis in a 7-week-old premature infant who subsequently tested positive for anti-HIV antibodies. A brief review of the topic is included.     

Renal abscess due to Escherichia coli in a child

Among the various intraabdominal abscesses, renal abscess is a rare entity, especially in children and accounts for a number of cases of "missed diagnoses." Drainage of pus and appropriate antibiotic therapy is the gold standard for treatment. Here we report a case of left renal abscess in a 6-year-old female child secondary to renal calculus. The patient presented with abdominal pain and mild fever for three months and the diagnosis was made by X-ray in the kidney, ureter and bladder (KUB) region, intravenous pyelography and ultrasonography of the abdomen. Escherichia coli was isolated from pus obtained by percutaneous drainage under sonographic guidance. The patient responded to intra-venous ceftriaxone, amikacin, and percutaneous drainage.     

Pyomyositis mimicking right iliac fossa mass: review of the literature

Pyomyositis is a pyogenic infection of skeletal muscle. Its incidence in temperate countries though low is rising. Most cases from the temperate region involve immuno-compromised patients. The onset is usually insidious with progression to large purulent collections. Because of its low incidence in temperate countries, it is often initially misdiagnosed. A high index of suspicion with appropriate imaging techniques, aggressive surgical intervention and adjunctive antibiotic therapy are the keys to prompt resolution. A case of pyomyositis mimicking right iliac fossa (RIF) mass is described with a review of the literature.     

Peliosis Hepatis in a Child with X-Linked Myotubular Myopathy Treated with Living-Donor Liver Transplant: A Case Report

BackgroundMyotubular myopathy is a rare disease sometimes accompanied by peliosis hepatis, a leading cause of fatal liver hemorrhage.Case ReportWe present a case of a 2-year-old boy with myotubular myopathy who developed liver hemorrhage because of peliosis hepatis and was successfully treated with living-donor liver transplant. The patient initially presented with fever, anemia, and liver dysfunction. A computed tomographic scan revealed hemorrhages in the liver, and the patient underwent hepatic artery embolization twice. After the second embolization, multiple peliosis hepatis cavities appeared in the left lobe of the liver that had increased in size. Therefore, the patient underwent ABO-incompatible living-donor liver transplant using a lateral segment graft from his father. The patient developed severe septic shock with an unknown focus on postoperative day 18, which resolved with antibiotic therapy. On postoperative day 62, he was discharged. Fourteen months after undergoing living-donor liver transplant, the patient showed no recurrence of peliosis hepatis.ConclusionsAlthough the long-term prognosis of peliosis hepatis due to myotubular myopathy after living-donor liver transplant remains unclear, liver transplant may be a curative treatment for patients with myotubular myopathy who have uncontrollable peliosis hepatis.     

Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases

Primary pyomyositis of the pelvic musculature is a condition rarely seen in temperate climates, although its frequency has been increasing in the United States. The condition should be considered in the initial differential diagnosis of an adolescent presenting with fever, difficulty ambulating, and hip pain. This is a retrospective review of 8 cases of primary pelvic pyomyositis in patients aged 18 years or younger who were treated at the Children's Medical Center in Augusta, Georgia. The site of infection was the obturator internus in the majority of the cases (5). The site was the gluteus, iliopsoas, and iliacus in 1 case each. Four patients who were diagnosed early responded to intravenous antibiotics with no need for further intervention. Two patients required incision and drainage of an abscess combined with antibiotics. Two patients had prolonged hospital courses requiring intensive unit care and mechanical ventilation. Blood cultures were positive in 87.5% of patients, and all patients presented with elevated acute phase reactants. One of the most difficult diagnostic aspects of presentation is an inconclusive symptom profile. It is noteworthy that patients with pelvic pyomyositis may present with limited range of motion in a specific plane (the motion placing the infected muscle on stretch) vs global limited range of motion of the joint as is commonly seen in septic arthritis. Early diagnosis is essential to prevent systemic illness and complications associated with this condition. Magnetic resonance imaging with gadolinium is helpful to diagnose and guide treatment.