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PubMed1994

Successful percutaneous drainage of gluteal pyomyositis occurring after intra-arterial chemotherapy and pelvic irradiation.

Pyomyositis, an unusual infection of large skeletal muscles, developed in a woman with a history of bulky stage IIIB cervical cancer. Three years prior, the woman had undergone aggressive neoadjuvant intra-arterial chemotherapy followed by pelvic irradiation. The overwhelming majority of pyomyositis cases is caused by Staphylococcus aureus. Group B beta-hemolytic streptococcus, an organism that rarely causes this infection, was isolated in this case. Although surgical drainage is the most common approach, successful percutaneous drainage was accomplished. Pyomyositis has only recently been reported in non-tropical climates. The presentation, diagnosis, risk factors, and management of pyomyositis are discussed.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

Magnetic resonance imaging of pyomyositis.

Pyomyositis is a relatively rare entity in temperate climates. Because of its rarity and its nonspecific clinical and radiographic findings, pyomyositis may be misdiagnosed and may cause severe morbidity and mortality. We present magnetic resonance imaging findings in two cases of pyomyositis. Magnetic resonance imaging was helpful in differentiating other pathological processes from pyomyositis, outlining the extent of involvement, and localizing the fluid collection.

Adolescent↗

PubMed2000

Staphylococcal pyomyositis in a patient with non-Hodgkin's lymphoma.

Pyomyositis is a rare disease, encountered mainly in tropical climates. The diagnosis of this entity is difficult, if not misdiagnosed, because of its rarity and its subacute presentation. We report of a 42-year-old man, in whom pyomyositis developed while he was receiving the standard chemotherapy for T-cell non-Hodgkin's lymphoma (NHL). Three months following splenectomy, multiple abscesses occurred in the muscles of both thighs while the patient was receiving the third course of the CHOP regimen. A purulent exudate was aspirated from the abscesses under computed tomographic guidance. Coagulase-positive Staphylococcus aureus was cultured in the aspirate. Pyomyositis was completely resolved following the surgical drainage and the antistaphylococcal antibiotic treatment. This patient has shown that immunosuppression due to splenectomy, NHL, and chemotherapy, especially when using steroids, could be risk factors for pyomyositis in nontropical or semitropical countries.

Adult↗

PubMed2001

Two cases of pyomyositis caused by Klebsiella pneumoniae and review of the literature.

Two patients with diabetes mellitus developed Klebsiella pneumoniae pyomyositis involving multiple muscles and other metastatic foci associated with bacteraemia. The cases are presented here, and the 22 cases of gram-negative pyomyositis reported previously in the literature are reviewed. As gram-positive cocci cause 99% of pyomyositis, it is postulated that the pathogenesis of pyomyositis may be associated with the ability of the bacteria to adhere to muscles by various cell surface adhesins that are not present in gram-negative bacilli. It is also postulated that a high serum glucose concentration may facilitate the growth and formation of the Klebsiella pneumoniae capsule, hence increasing its virulence and causing serious disseminated Klebsiella infections in diabetic patients.

Adult↗

PubMed2003

[Pyomyositis in an immunocompetent adult: unusual complication of rhabdomyolysis].

INTRODUCTION: Non-tropical pyomyositis is a commonly reported infection in immunodeficient patients' muscle but is rare without immunodeficiency. CASE DESCRIPTION: We report the case of a 40-year-old woman admitted in the physical medicine and rehabilitation department for a motor and sensory loss of the lower limb; this disorder appeared after rhabdomyolysis due to prolonged lying position (suicide attempt). The initial diagnosis of sciatic nerve compression was not consistent with motor loss of adductor muscles. Clinical examination revealed soft tissue swelling in the proximal part of her lower limb. CT scan displayed pyomyositis of the thigh (hip adductors and gluteus medius), which was successfully treated by surgical incision and drainage in combination with antibiotherapy. CONCLUSION: Non-tropical pyomyositis is rarely described without immunodeficiency but this diagnosis should be borne in mind when previous muscle trauma is associated to leukocytosis. Computed tomography and MRI are the tests of choice to confirm the diagnosis of pyomyositis and to differentiate it from other entities.

Anti-Bacterial Agents↗

PubMed1984

Pyomyositis in a neonate.

Pyomyositis, better known as tropical pyomyositis in other areas of the world, is a relatively rare condition in temperate climates such as the United States. The disease is a bacterial infection of muscle with abscess formation usually caused by Staphylococcus aureus. Skin findings are rare until late in the course of the disease. We present a 3-week-old male infant in whom skin findings were an early presentation. This is the first known case of pyomyositis in a neonate in the United States and the only known case of pyomyositis reported in the dermatologic literature. A high index of suspicion is needed, because considerable delay in accurate diagnosis can occur.

Diagnosis, Differential↗

PubMed2005

[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.

Abdominal Abscess↗

PubMed1994

Case report: diabetes mellitus as a predisposing factor in the development of pyomyositis.

Pyomyositis is an uncommon infection in temperate climates, usually resulting from Staphylococcus aureus infection of skeletal muscle. In this report, the authors describe a patient with untreated Type 2 diabetes mellitus who suffered nonpenetrating blunt trauma to his left anterior thigh, and S. aureus pyomyositis and secondary osteomyelitis of his proximal tibia and patella subsequently developed as a result of delayed diagnosis and treatment. Patients with diabetes mellitus are at increased risk for the development of pyomyositis because of more frequent S. aureus colonization of skin, nasal mucosa, and oropharynx; a delay in definitive treatment can lead to significant morbidity in these patients. Computed tomography or magnetic resonance imaging may be helpful in the diagnosis of pyomyositis. An anemia of chronic disease may result from this disorder, which resolves with treatment.

Biopsy, Needle↗

PubMed1990

Pyomyositis and human immunodeficiency virus infection.

Pyomyositis is a bacterial infection of skeletal muscle usually caused by Staphylococcus aureus and characterized by localized muscle pain, swelling, and tenderness. The disease is endemic in the tropics. Though only approximately 50 cases have been reported from the continental United States, pyomyositis has been increasingly recognized here in the last decade. We report two patients with human immunodeficiency virus (HIV) infection and pyomyositis, and review five previously reported cases. Given the predisposition of patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) for infections caused by S aureus, pyomyositis may become increasingly more common in temperate areas.

AIDS-Related Complex↗

PubMed2004

Physical signs in pyomyositis presenting as a painful hip in children: a case report and review of the literature.

The incidence of pyomyositis is on the increase worldwide among children and adults. When it involves muscles about the hip it needs to be differentiated from septic arthritis and transient synovitis among other diseases. Lack of awareness of the condition frequently leads to delay in correct diagnosis. We present one case of pyomyositis of the gluteus maximus and another rarer case of obturator internus pyomyositis that posed difficulties in initial diagnosis. While magnetic resonance imaging remains the imaging method of choice, we highlight important physical signs in the examination of patients presenting with a painful hip, which should raise suspicion of pyomyositis.

Anti-Bacterial Agents↗

PubMed1996

Pyomyositis during induction chemotherapy for acute lymphocytic leukemia.

PURPOSE: Pyomyositis is a rare disease in temperate climate regions and frequently has a subacute presentation. Because of this, the entity is often misdiagnosed. PATIENTS AND METHODS: Two boys with acute lymphocytic leukemia (ALL) who presented with muscle pain, shortly after receiving induction chemotherapy, were evaluated. RESULTS: Presenting physical examination and laboratory findings were unremarkable except for extremity pain and tenderness. These symptoms were initially attributed to a neurotoxic side effect of vincristine. As the children's symptoms progressed, muscle abscess formation was finally delineated by gallium and computed tomography scans, and the diagnosis of pyomyositis was made. In both cases, the invading organism was Staphylococcus aureus. Both children responded well to incision and drainage of the abscesses and antibiotic therapy. CONCLUSION: Four cases of pyomyositis occurring in ALL patients shortly after induction chemotherapy have now been described. We feel that when children from this population present with muscle pain, pyomyositis should be part of the differential diagnosis. With early medical and surgical intervention, morbidity and mortality can be avoided.

Abscess↗

PubMedDate not supplied

Pyomyositis in children.

Bacterial infections of muscle, also known as pyomyositis or tropical pyomyositis, occur more commonly in tropical regions. This article reviews five cases of pyomyositis diagnosed in children over a 1-year period. Pyomyositis should be considered in the differential diagnosis of septic-appearing children as well as children complaining of joint pain or muscle aches. The diagnosis can be aided with either a computed tomography (CT) or magnetic resonance imaging (MRI) scan. The MRI is preferable because multiple processes can be evaluated, such as joint effusion suggesting septic arthritis. If the patient does not respond quickly to antibiotics and surgical intervention, either there is a recurrence of the previously debrided abscess, or there is an unrecognized secondary abscess. Multiple abscess sites should be entertained prior to initial debridement.

Abscess↗

PubMed1993

Pyomyositis and staphylococcal scalded skin syndrome.

Pyomyositis is a rare musculoskeletal infection in non-tropical countries. We report a child who had pyomyositis complicated by staphylococcal scalded skin syndrome. This complication has not previously been described in patients with pyomyositis. Early diagnosis of pyomyositis was made by ultrasound examination, and percutaneous needle drainage under ultrasound guidance was performed. Pus aspirated and blood cultures grew Staphylococcus aureus. No open surgical drainage was required and resolution of the abscess was documented by serial ultrasound examinations.

Child↗

PubMed1998

Pyomyositis associated with Bacteroides fragilis in a patient with multiple myeloma.

Pyomyositis is an infection of the skeletal muscle that is usually caused by Staphylococcus aureus. We report a 68-year-old Japanese woman who developed pyomyositis caused by Bacteroides fragilis following treatment for multiple myeloma. There are only two cases of pyomyositis associated with multiple myeloma in the literature. After receiving melphalan and prednisolone for five days, she developed multiple abscesses in the muscles of the right arm and thigh. Purulent exudate was aspirated from the abscess, and B. fragilis was identified. This is the first case of B. fragilis pyomyositis. Magnetic resonance imaging aided the diagnosis. Treatment consisted of surgical incision and drainage, with antibiotic administration. The immunosuppression caused by the myeloma and/or the chemotherapy presented a risk factor for the unusual infection observed in this patient.

Abscess↗

PubMed2003

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.

Aged↗

PubMed2005

Contribution of imaging to the evaluation of pyomyositis.

PURPOSE: To analyse the fundamental features of each imaging modality with the aim of defining their contribution to the diagnosis of pyomyositis. MATERIALS AND METHODS: We retrospectively reviewed 10 observations collected between 1997 and 2004, 5 of paravertebral muscles and 5 of the muscles of the limbs. Imaging was carried out with US (8/10 observations) and/or CT (9/10 observations), and/or MRI (6/10 observations). The pathogen was isolated in 6/10 observations. RESULTS: The imaging criteria for the detection and characterization of pyomyositis are based on three pathological phases: an invasive phase characterized by inflammatory oedema, a suppurative phase characterised by abscess development, and a late phase featuring the distant spread of the infection. Based on these interpretation criteria, pyomyositis was correctly diagnosed with US in 5/8 observations, with CT in 9/9 observations and with MR in 5/6 observations. Four false-negative cases were found. CONCLUSIONS: Since the clinical symptoms of pyomyositis are often insidious and delayed, an integrated imaging approach may be very useful for diagnosing this condition.

Adult↗

PubMed1991

Staphylococcal pyomyositis in patients infected by the human immunodeficiency virus.

PURPOSE: We describe the manifestations of spontaneous staphylococcal pyomyositis in patients infected by the human immunodeficiency virus (HIV). PATIENTS AND METHODS: We present the courses of five previously unreported patients infected by HIV who presented to our medical centers with spontaneous staphylococcal pyomyositis. Additionally, we review all previously reported cases of this entity in HIV-infected patients and discuss its possible pathogenesis and importance in the context of HIV infection. RESULTS: All patients presented with gradually developing fever and localized pain and swelling without accompanying leukocytosis. Often only scant evidence of local inflammation was found. None of our patients used intravenous drugs, had a history of trauma, had HIV- or zidovudine-related myositis, or had other conditions known to be associated with serious staphylococcal infections. Two patients studied had normal serum levels of all IgG subclasses. Elevated serum IgE, eosinophilic inflammatory infiltrates, or marked peripheral eosinophilia was observed in two patients. CONCLUSIONS: Staphylococcal pyomyositis in HIV-infected patients presents in an indolent fashion, which may delay appropriate diagnosis and treatment. Since staphylococcal pyomyositis is infrequently reported in the United States, the development of 14 such cases (five in this series and nine previously reported) among the first 140,000 cases of acquired immunodeficiency syndrome in this country implies that this patient population is predisposed to this infectious complication. The pathogenesis of this entity is uncertain, but it is notable that HIV-infected patients are commonly colonized by Staphylococcus aureus and that neutrophils from HIV-infected patients frequently manifest phagocytic, chemotactic, and oxidative defects, diminished expression of Fc tau RIII (CD16) and CR1, and impaired bactericidal activity against S. aureus.

Acquired Immunodeficiency Syndrome↗

PubMed1990

[Primary pyomyositis in mild climates. Presentation of 2 new cases].

Pyomyositis is an acute bacterial infection which affects striated muscles. It is a relatively rare process in mild climates. Staphylococcus aureus is responsible for 90-95% of cases. Klebsiella pneumoniae pyomyositis is extremely rare with only one other case reported in a mild climate. Two new cases of pyomyositis are described one caused by K. pneumoniae, increasing thus the etiology spectrum in our country, and the other caused by S. aureus ending in fatality, with two focus of pyomyositis (one of which was chronic) and multisystemic secondary affectation. We highlight the appearance of this process in our environment and the necessity to keep it in mind when making a differential diagnosis in order to recognize it and treat it as soon as possible since its prognosis depends on the moment the diagnosis is made.

Adult↗