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Necrotizing soft tissue infection, with or without myositis, is classified among the most dangerous infectious emergencies in clinical practice. The authors report a case of an older diabetic woman who presented to the orthopedic service with right elbow pain after a small trauma with skin abrasion and released with an analgesic prescription. After 48h, she presented to the emergency room with a history of developing bullous and necrotic lesions in the upper right limb, hypotension, and numbness, with rapid and fatal evolution despite adequate clinical and surgical therapeutic support. Muscle biopsy showed necrotizing myositis. Blood culture was positive for Panton-Valentine leukocidin producing (PVL-positive) methicillin-resistant S. aureus. Although PVL has a strong epidemiologic association with Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, it can also be found in CA-MSSA in the context of necrotizing pneumonia and skin and soft tissue infections. Although infrequent, CA-MRSA or CA-MSSA PVL+ infections should always be suspected in high-risk patients because they can rapidly evolve with severe, sometimes fatal complications., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A 73-year-old woman with medical history of diabetes and hypertension presented with right-sided back pain and night sweats of 1 month duration. On physical examination, there was costovertebral angle tenderness and her urinalysis was indicative for urinary tract infection. She was admitted and managed with intravenous antibiotics. On initial imaging, there was a right-sided retroperitoneal mass adjacent to right kidney. This was investigated further with MRI, which showed diffuse inflammation of right paraspinal muscles with two loculated abscesses. The abscesses were aspirated and the culture sent grew Streptococcus agalactiae (Group B Streptococcus) and the patient was treated with 6-week course of intravenous antibiotics., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Aspergillus myofasciitis is a rare infection of the muscles and their fascial sheaths that has been reported in patients with immune deficiencies of various kinds but, until now, not with chronic granulomatous disease (CGD). Patients affected by CGD are at high risk of invasive aspergillus infections. The case described involves a 14-year-old boy with a severe autosomal recessive CGD who was admitted to hospital with an Aspergillus myofasciitis of the left forearm. He was treated with liposomal amphotericin for 14 days and then with oral voriconazole for three months with an excellent clinical outcome. He did not evidence any recurrence in the following 30 months using itraconazole prophylaxis.

Pyomyositis is classified into two main types: tropical and non-tropical. Non-tropical pyomyositis occurs among various immunocompromised patients, and Staphylococcus aureus has been reported as the most common pathogen. Pyomyositis caused by Streptococcus pneumoniae is uncommon, and has not been previously reported after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Here, we report a unique case with pyomyositis caused by S. pneumoniae in the bilateral erector spinae muscles 34 months after allo-HSCT. The patient had an initial clinical response following the administration of intravenous benzylpenicillin potassium for 4 weeks. Although S. pneumoniae bacteremia is a rare bacterial infection after HSCT, the possibility of pyomyositis must be considered when a recipient develops S. pneumoniae bacteremia. Accurate diagnosis and the selection of appropriate antibiotics are necessary for the treatment of pyomyositis., (Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Pyomyositis is a rare, subacute, deep pyogenic infection of the muscle tissue. This disease has been previously described in patients that were immunocompromised due to a hematological malignancy., Case Presentation: A 68-year-old man with a history of chronic myeloid leukemia was treated with imatinib. He was diagnosed with ascending colon cancer and underwent curative surgery. His postoperative course was uneventful, and he was healthy at 6 months after surgery, allowing for reinitiation of imatinib therapy. After the reinitiation of therapy, a computed tomography (CT) scan revealed a mass shadow in the right iliopsoas muscle. This lesion was clinically diagnosed as recurrent colon cancer with an abscess, which was resected surgically. A pathological examination uncovered both edema and inflammation. Two months after the second surgery, imatinib therapy was reinitiated; however, he again developed painful swelling and erythema in his right thigh. A CT scan revealed a similar shadow as described previously. He was then diagnosed with pyomyositis; he underwent incisional drainage and was administered linezolid. Following the treatment for pyomyositis, there was no cancer recurrence or evidence of any recurrent pyomyositis., Conclusions: Findings from this case suggest that both undergoing surgery and receiving imatinib therapy may modulate an individual's immune response, whereby the surgical site becomes more prone to infection and may predispose an individual to pyomyositis. The case report is followed by a discussion of the literature regarding this disease, including potential risk factors and the underlying pathogenesis.

A 26-year-old woman with paranoid schizophrenia was admitted to the medical intensive care unit with septic shock requiring intubation and mechanical ventilation. The source of septic shock was not identified despite obtaining CT of the chest/abdomen/pelvis, bronchoalveolar lavage and microbiological results for tracheal secretions, blood, urine and cervix. An indium-111 tagged white cell count scan was subsequently performed, revealing increased right anterior deltoid uptake. Owing to serial increases (up to 1310 U/L) in serum creatine kinase and a history of local intramuscular paliperidone injections for management of schizophrenia, surgical exploration was performed and identified necrotising skeletal muscle inflammation and extensive fat necrosis with an organising abscess, consistent with pyomyositis. A gram stain of purulent fluid revealed gram-positive cocci, but no organisms grew in culture. The patient recovered after 10 days of daptomycin and 7 weeks of wound care. Paliperidone injections were discontinued and oral risperidone was initiated., (2015 BMJ Publishing Group Ltd.)

Introduction: Pyomyositis, though classically considered a tropical disease, has a variable geographic prevalence. Among the predisposing risk factors, immunodeficiency plays an important role. Pyomyositis has a tendency to mimic more commonly considered diseases, and a lack of familiarity with it is a cause of delayed diagnosis., Case Presentation: A 53-year-old South Asian man with newly diagnosed type 2 diabetes mellitus was referred to our medical unit in an advanced stage of the disease, which was complicated by sepsis and acute kidney injury. Failure of the referring unit to provide prompt treatment, as well as their delay in coming to a diagnosis, led to the patient's complicated state. Antibiotic therapy was initiated, and clinical stabilization was achieved with supportive measures. Following the patient's recovery from sepsis, his persistent leukopenia and anemia was suggestive of an underlying immunodeficiency, and a subsequent bone marrow biopsy revealed acute myeloid leukemia, M2 variant. Multi-disciplinary care was initiated by the medical, surgical and oncological teams., Conclusion: Awareness of tropical pyomyositis is lacking. Common predisposing behaviors and conditions should always be sought and investigated. Immunosuppressive state is an important predisposing factor in the pathogenesis of pyomyositis. Early antibiotic treatment is pivotal in management, and surgical intervention, when relevant, should not be delayed. Identifying one cause should not halt the search for others, as pyomyositis may herald underlying sinister diseases.

Pyomyositis is a rare disease in temperate climates. This case is a unique presentation of pyomyositis of the rectus abdominal muscle mimicking an acute abdominal process. Most reported cases of pyomyositis are of extremity infections with Staphylococcus aureus.This report presents a case of polymicrobial pyomyositis from Haemophylus parainfluenza and Steptococcus viridians infection.

Panton-Valentine leukocidin-producing Staphylococcus aureus osteomyelitis is associated with multiple complications including multiple abscesses, deep vein thrombosis and fulminant sepsis. This article reviews the literature concerning this emerging threat which is currently under-recognized.

An inflammatory or infectious disease of the oesophagus occurring in tissue layers beneath but sparing the mucosa may pose a diagnostic challenge. Bacterial pyomyositis has been previously reported occurring mostly in the skeletal muscle. Pyomyositis involving the gastrointestinal tract is extremely rare, and may easily be misdiagnosed due to its nonspecific clinical features. We report a case of an intravenous drug user who presented with oesophageal pyomyositis. Early computed tomography facilitated accurate diagnosis. Adequate drainage followed by antibiotic treatment was effective and the oesophagus was preserved. To the best of our knowledge, this is the first report of a case of oesophageal myositis in an intravenous drug user., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

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., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

A 10-year-old boy presented to the emergency department with chief symptoms of fever and right leg pain for 3 days. Also of note, he reported that he had a boil on his neck 2 weeks prior to admission. This lesion was lanced by his mother with a hot needle. An X-ray, CT scan and MRI of the right knee showed no evidence of osteomyelitis. He was placed on intravenous vancomycin for empiric treatment. Blood culture grew methicillin-susceptible Staphylococcus aureus (MSSA), susceptible to vancomycin and clindamycin. He continued to spike fever with the development of erythema, and swelling of the distal thigh. Repeat MRI of the right knee showed osteomyelitis and subperiosteal abscess in the distal femur shaft with surrounding intramuscular abscesses and pyomyositis. He was taken to the operating room where 50 mL of fluid was drained from the periosteal abscess and a bone biopsy was obtained. Bone marrow culture also grew MSSA, susceptible to clindamycin.

A 33-year-old athletic male was unexpectedly found dead in his bed. For several days prior to his death he complained of tenderness and swelling of his right buttock. The post-mortem examination revealed unilateral pale gluteal muscles and pustular impetiginized skin lesions of the right lower leg. The muscle histology demonstrated pronounced acute inflammation and limited necrosis of muscle fibers confined to the right gluteal muscles. Vascular occlusion and renal abnormalities were excluded by post-mortem angiography and histology respectively, and the diagnosis of non-tropical pyomyositis, possibly originating from the dermatological infection, was made. Toxicological testing revealed a potentially lethal intoxication with fentanyl and morphine. Pyomyositis is etiologically attributed to an infection and predominantly affects large limb or trunk muscles. Males are affected more frequently than females. Histologically, it is dominated by acute inflammatory infiltrates and may lead to sepsis and subsequent death. Although occurring less frequently, pyomyositis must be considered in the differential diagnosis of macroscopic localized muscle pallor, together with vascular occlusion and rhabdomyolysis. In such cases, only the examination of fresh frozen muscle tissue samples from different locations, together with the histological examination of the internal organs, particularly the kidneys, will facilitate the confirmation of the correct diagnosis.

Varicella-zoster is a common paediatric viral infection that usually runs a benign self-limiting course but has a risk of complications. The most common sequelae are bacterial skin infections, which are usually mild. However, bacteraemia/septic shock, toxic shock syndrome, pneumonia, ataxia, encephalitis and purpura fulminans are also possible. Although rare, musculoskeletal sequelae (osteomyelitis, septic arthritis, pyomyositis and necrotizing fasciitis) can occur in otherwise healthy children. These latter complications are potentially life- and limb-threatening and must be considered in a child post-varicella with pain in a limb or joint. We describe two patients who had musculoskeletal complications after varicella: (1) a 16-month-old boy who developed pyomyositis of the thigh and septic arthritis of the hip and (2) a two-year-seven-month-old girl who developed septic arthritis of the hip and knee and a 'bare area' subperiosteal abscess of the femur. Their clinical presentations, detailed management plans and outcomes are reported. These cases highlight the importance of prompt diagnosis, appropriate investigation (including the important role of magnetic resonance imaging) and surgery when an otherwise healthy post-varicella child deteriorates.

Primary pyomyositis is a subacute deep bacterial infection of skeletal muscle. It is typically seen in tropical countries with Staphylococcus aureus being the commonest pathogen. Immunocompromised states and trauma are associated with cases in temperate climates where there is an increasing incidence, typically in children and young adults. However, the authors present a case of primary pyomyositis in a previously healthy 80-year-old female. The authors highlight the potential difficulties in early diagnosis of this rare condition in the UK indicating the need for early MRI imaging and the low sensitivity of blood cultures and serum creatine kinase measurements. Treatment, including early surgical drainage and appropriate antibiotic therapy, is discussed.

Pyomyositis is a purulent infection of skeletal muscle that arises from hematogenous spread, usually with abscess formation. Necrotizing fasciitis is a more severe, rapidly progressive infection involving the superficial and deep fascia with necrosis and fluid collections that can be life threatening if left untreated. Both conditions may coexist, and concomitant cellulitis is often seen. A high incidence of these diseases occurs in the tropics, but they are increasingly being seen in temperate countries, due in part to their association with immunodeficiency conditions such as human immunodeficiency virus (HIV) infection, diabetes mellitus, and organ transplantation. This article aims to familiarize physicians with these entities, review their clinical manifestations and imaging features, and highlight the role of imaging in the management of patients with these conditions., (© Thieme Medical Publishers.)

Primary or tropical pyomyositis is a subacute infection of the skeletal muscle complicated by abscess formation. The disease is rare in the temperate climates and often misdiagnosed because of the vague clinical presentation. We herein report a case of a 38-year-old diabetic patient with a history of recent bone marrow biopsy presented multifocal primary pyomyositis complicated by meningitis.

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.

Multiple diagnostic imaging modalities are available and beneficial for the evaluation of the diabetic foot. There is not yet "one best test" for sorting out the diagnostic dilemmas commonly encountered. The differentiation of cellulitis alone from underlying osteomyelitis and the early detection of abscesses remain important diagnostic goals. Equally important, differentiation of osteomyelitis and neuroarthropathy remains a difficult job. This is often compounded by postoperative diabetic foot states status after reconstruction. Diagnostic evaluation often involves multiple studies that are complementary and that include conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, ultrasonography, and positron emission tomography.

Pyomyositis is a primary infection of the skeletal muscle, occurring most commonly in tropical countries. Adults who develop the disease have, in most cases, associated comorbidities that compromise the immune system, including diabetes mellitus and liver cirrhosis.

There are several musculoskeletal conditions that are specific or unique to the patient infected with human immunodeficiency virus (HIV). These conditions affecting the patient with HIV can be divided into 4 categories: disseminated diseases, bone disorders, joint disease, and myopathies. This review focuses on the manifestations of HIV on musculoskeletal disease as they relate to the emergency physician., (Copyright 2010 Elsevier Inc. All rights reserved.)

Tropical pyomyositis, a disease often seen in tropical countries, is characterized by suppuration within the skeletal muscles, manifesting as single or multiple abscesses. Staphylococcus aureus is the most common agent responsible for typical pyomyositis. Misdiagnosis usually occurs as a result of nonspecific presentation, unfamiliarity with the disease, and the many possible differential diagnoses. Here we present a rare case of tropical pyomyositis caused by Salmonella (group D non-typhi Salmonella) within the gluteus maximus of a hepatitis B carrier without definite previous gastrointestinal episodes.

Background: A case of methicillin-resistant Staphylococcus aureus (MRSA)-pyomyositis in association with acute myelogenous leukemia (AML) is reported. MRSA-sepsis developed in a 51-year-old Japanese man with AML, during the neutropenic period after high-dose 1-beta-d-arabinofuranosylcytosine (Ara-C). Although the MRSA-sepsis initially improved with arbekacin sulfate (ABK) administration, a high fever recurred with left thigh pain despite recovery of the neutrophil count after ABK was stopped. A computed tomographic (CT) scan showed a low-density area in the left quadriceps femoris muscle, which led to a diagnosis of pyomyositis. MRSA was cultured from the abscess aspirates. The fever and thigh pain disappeared after administration of ABK and minocycline hydrochloride (MINO), and the abscess completely disappeared with the oral administration of levofloxacin (LVFX) for about 3 months., Conclusion: If an immunocompromised patient complains of fever and muscle pain after intensive chemotherapy, MRSA-pyomyositis should be considered.

Pyomyositis is an infection of skeletal muscle that involves the formation of intramuscular abscesses. It occurs most commonly in immunocompromised patients. Pyomyositis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has never been reported in the literature. A 48-year-old female patient developed ESBL-producing E. coli bacteremia and pyomyositis on the twelfth day of cefpirome therapy for neutropenic fever after chemotherapy due to acute myeloid leukemia. She recovered completely after a three-week course of meropenem and surgical excision. Pyomyositis should be included in the differential diagnosis when fever and muscular swelling develop in a patient with neutropenic status after chemotherapy. Early recognition of symptoms and proper diagnostic procedures are key to diagnosing pyomyositis. Both adequate antibiotics and surgical intervention are important for the successful treatment of pyomyositis caused by ESBL-producing E. coli.

Background and Purpose: Primary pyomyositis is increasingly recognized in non-tropical areas, its incidence seeming to mirror the increase in immunocompromised populations. In this study, we sought to analyze the differences in clinical characteristics, causative organisms, treatment and outcome between pyomyositis patients with and without underlying diseases., Methods: Thirty five patients with a diagnosis of primary pyomyositis seen in our hospital between July 1989 and July 2006 were enrolled. Descriptive information concerning age, gender, clinical features, underlying comorbid diseases, results of blood tests, blood culture, muscle or pus culture, disease severity and clinical stages at the time of diagnosis, therapy, and outcome were collected by review of medical charts., Results: Of the 23 cases with underlying diseases, the mean age was 47.8 years (range, 24 to 79 years). Of the 12 patients without underlying diseases, the mean age was 26.2 years (range, 2 to 72 years). The lower extremities was the most common site of involvement. Staphylococcus aureus was the most frequent causative organism. Gram-negative organisms were isolated in 30.4% of patients with underlying diseases and in none of the patients without underlying diseases (p=0.07). Positive blood culture was significantly more common in patients with underlying diseases than in patients without underlying diseases (52.2% vs 8.3%, p=0.013). The mortality rate was higher in patients with underlying diseases than in patients without underlying diseases (39.1% vs 0.0%, p=0.015). White blood cell count (p=0.017), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p<0.001), recurrence (p=0.004), and presence of underlying diseases (p=0.015) were significant prognostic factors for mortality by univariate analysis. APACHE II score (odds ratio, 1.57; 95% confidence interval, 1.13 to 2.20; p=0.008) was found to be a significant independent risk factor for mortality in multivariate logistic regression analysis. For prediction of mortality, the best cut-off point in APACHE II score was 16 (sensitivity, 77.8%; specificity, 92.3%; accuracy, 88.6%)., Conclusions: Patients with primary pyomyositis should be treated with appropriate broad-spectrum antibiotics and be monitored closely for complications. This study found that patients who suffered from primary pyomyositis with underlying diseases had a higher rate of Gram-negative bacterial infections, bacteremia and mortality. The APACHE II score at diagnosis was found to be an independent prognostic factor for mortality.

Purpose of the Study: By presenting the results of treatment of secondary pyomyositis of deep hip muscles, to draw attention to the seriousness of this complication occurring in association with pelvic and lumbo-sacral infections., Material and Methods: The course of disease was evaluated retrospectively in a group of 13 patients with an average age of 65.8 years treated in the period from April 2004 to June 2007. The imaging methods used included native radiography, ultrasonography (SONO), computed tomography (CT) and magnetic resonance imaging (MRI). Markers of inflammation, i.e., C-creative protein, erythrocyte sedimentation rate and WBC differential count, were used to assess the intensity of inflammation. At stage 1, patients were treated conservatively, with appropriate antibiotic therapy. At stages 2 and 3, surgical procedures were used (incision, abscess evacuation and drainage) or abscess was treated by CT-guided needle puncture and pigtail drain insertion. The evaluation took into account survival of the patients in relation to the stage of their disease, early detection of origin of infection, therapy initiation, and other factors putting patients at risk., Results: Of the 13 patients treated, 10 had stage 3 pyomyositis with beginning or developed multiple-organ failure when they were referred to our institution from outside hospitals; three admitted at stage 2 pyomyositis were in relatively good state. Ten patients were cured, two died due to multiple-organ failure and one due to pulmonary embolism after lower-extremity phlebothrombosis. The success of treatment appeared to be related to early surgical intervention., Discussion: A good outcome of therapy depends on an early diagnosis and treatment of the underlying infection and pyomyositis. To establish the diagnosis of pyomyositis, repeated clinical, laboratory and bacteriological examinations are necessary, as well as the use of imaging methods, namely SONO, CT and MRI. Treatment may be complicated when small multiple abscesses develop deep in the hip muscles where surgical intervention is difficult., Conclusions: Secondary pyomyositis is a serious, life-threatening complication of the underlying infection. The outcome of the disease depends on early diagnosis, therapy and the patient's overall state. Stage 1 pyomyositis (muscle oedema) is treated conservatively with antibiotics. Stage 2 pyomyositis needs surgical intervention with abscess aspiration and drainage; in some cases CT-guided needle puncture with pigtail drain insertion is sufficient. An appropriate antibiotic course is obligatory. Stage 3 pyomyositis associated with septic shock or multiple-organ failure requires a comprehensive care in an acute medicine department. In polymorbid patients prognosis is poor and treatment is expensive and often unsuccessful.

Pyomyositis is a rare primary bacterial infection of the skeletal muscles. Pyomyonecrosis is the most severe manifestation of this disease and is associated with a potentially devastating outcome. Patients with peripheral vascular disease presenting with pyomyositis may be difficult to distinguish from those with critical ischemia or synthetic graft sepsis. This article reports on a patient with aortobifemoral bypass graft and severe vitamin B(12) deficiency who developed pyomyonecrosis and aortoduodenal fistula. This article highlights the etiologic dilemma, diagnostic difficulties, and management challenges inherent in such cases. Pitfalls in our management of this patient are discussed.

Pyomyositis is a purulent infection of skeletal muscle characterized by fever, localized muscle pain and stiffness, swelling and tenderness. Hematological disorder is one of the predisposing conditions for the development of pyomyositis. A 54-year-old man developed methicillin-resistant Staphylococcus aureus pyomyositis during drug-induced pancytopenia. Debridement of the infection foci combined with antimicrobial agents proved effective even in the advanced stage of the disease. In patients with hematological disorders, pyomyositis should be considered when evaluating local myalgia and high fever because this disease can be very difficult to identify and can become rapidly progressive under a myelosuppressive condition.