BACKGROUND/AIMS: Pyomyositis is an infective condition with primary involvement of the skeletal muscles. There is sparse recent literature on patients with pyomyositis. METHODS: This study was carried out at emergency services of a tertiary care center located in subtropical area of Indian subcontinent. RESULTS: Sixty-two patients of primary pyomyositis formed the study cohort. Mean age of occurrence was 29.9 ± 14.8 years. There were 54 men. Twelve patients had underlying medical diseases. Muscle pain was seen in all 62 patients. Forty-eight patients (77.4%) had the fever. Most common site of involvement was thigh muscles (n = 29, 46.8%). Forty-nine patients (79%) presented in the suppurative stage of illness. Patients with comorbidities were older (age: median 36 years [interquartile range (IQR), 25 to 47] vs. 24 years [IQR, 16 to 35], p = 0.024), had higher culture positivity with gram-negative organisms (8/9 [88.89%] vs. 6/29 [20.69%], p = 0.001). Importantly, higher number of these patients received inappropriate antibiotics initially. Patients with positive pus culture result had higher complication rate (32/38 [84.21%] vs. 10/18 [55.56%], p = 0.044). Six patients (9.7%) had in-hospital mortality. Lower first-day serum albumin, initial inappropriate antibiotic therapy, and advanced form of the disease at presentation were associated with increased in-hospital mortality. CONCLUSIONS: Primary pyomyositis is not an uncommon disease entity. Patients with comorbidities were more likely to receive initial inappropriate antibiotic therapy. Patients with positive pus culture report had the higher rate of complications. Lower first-day serum albumin, initial inappropriate antibiotic therapy and advanced form of the disease at presentation were associated with increased in-hospital mortality.
Anti-Bacterial Agents ; Cohort Studies ; Comorbidity ; Emergencies ; Fever ; Hospital Mortality ; Humans ; India* ; Male ; Muscle, Skeletal ; Muscles ; Myalgia ; Outcome Assessment (Health Care)* ; Pyomyositis* ; Serum Albumin ; Suppuration ; Tertiary Care Centers ; Thigh

Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.
Adult ; Cellulitis ; Communicable Diseases ; Diabetic Foot ; Diagnosis ; Erysipelas ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Immunocompromised Host ; Impetigo ; Methods ; Pyomyositis ; Skin* ; Soft Tissue Infections*

Diabetes mellitus (DM) can accompany many musculoskeletal (MSK) diseases. It is difficult to distinguish the DM-related MSK diseases based on clinical symptoms alone. Sonography is frequently used as a first imaging study for these MSK symptoms and is helpful to differentiate the various DM-related MSK diseases. This pictorial essay focuses on sonographic findings of various MSK diseases that can occur in diabetic patients.
Adult ; Cellulitis/ultrasonography ; Diabetes Mellitus, Type 2/*complications ; Diabetic Neuropathies/ultrasonography ; Female ; Humans ; Male ; Musculoskeletal Diseases/complications/*diagnosis/ultrasonography ; Pyomyositis/microbiology/ultrasonography ; Tenosynovitis/microbiology/ultrasonography ; Vascular Diseases/ultrasonography

Septic pulmonary embolism is an uncommon disorder in which septic thrombi are mobilized from an infectious nidus and transported in the vascular system of the lungs. We report a case of a 52-year-old immunocompetent female who suffered from septic pulmonary embolism associated with polymyositis, deep venous thrombosis and pericardial effusion. Oxacillin-sensitive staphylococcus aureus (MSSA) was isolated from her sputum. Clinical presentation improved after incision of the muscle abscess and vancomycin treatment.

Human ; Female ; Middle Aged ; Abscess ; Communicable Diseases ; Oxacillin ; Pericardial Effusion ; Polymyositis ; Pulmonary Infarction ; Sputum ; Staphylococcal Infections ; Staphylococcus Aureus ; Vancomycin ; Venous Thrombosis ; Pyomyositis

No abstract available.
Acute Disease ; Aged ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Buttocks ; Debridement ; Diabetes Mellitus, Type 2/*complications/diagnosis ; Escherichia coli Infections/diagnosis/drug therapy/*microbiology ; Female ; Humans ; Microbial Sensitivity Tests ; Muscle, Skeletal/*microbiology/surgery ; Pyelonephritis/diagnosis/drug therapy/*microbiology ; Pyomyositis/diagnosis/*microbiology/therapy ; Tomography, X-Ray Computed ; Treatment Outcome

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.
*Acromioclavicular Joint/microbiology ; Adult ; Anti-Bacterial Agents/administration & dosage ; Arthritis, Infectious/diagnosis/microbiology/*therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Pyomyositis/diagnosis/microbiology/*therapy ; Staphylococcal Infections/complications/*therapy ; *Staphylococcus aureus ; *Sternoclavicular Joint/microbiology

Obturator internus pyomyositis is a rare disease that is more commonly found in tropical countries. Due to its infrequent occurrence, it is a differential of hip pain that has not been sufficiently considered, which often results in delayed diagnosis. We present a case report of a 4 year old boy with pyomyositis of obturator internus as well as externus. He was treated successfully with intravenous antibiotics. A comparison is made with other case reviews to identify symptoms and signs that could help in diagnosing the condition early and accurately so as to initiate intravenous antibiotics, the mainstay treatment in a timely fashion, eventually avoiding surgical drainage of the sequelae when it becomes an abscess.
Pyomyositis

Sacroiliac joint block can be performed for the diagnosis and treatment of sacroiliac joint dysfunction. Although sacroiliac joint block is a common procedure, complications have not been reported in detail. We report a case of iliacus pyomyositis and sacroiliac joint infection following a sacroiliac joint block. A 70-year-old female patient received sacroiliac joint blocks to relieve pelvic pain. The patient was admitted to the emergency room two days after the final sacroiliac joint block (SIJB) with the chief complaints of left pelvic pain corresponding to a visual analogue scale (VAS) score of 9 and fever. A pelvic MRI indicated a diagnosis of myositis. After 1 month of continuous antibiotic therapy, the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level remained elevated. A 67Ga SPECT/CT was done. Abnormal uptake was seen at the left sacroiliac joint (SIJ), and septic sacroiliitis was suspected. The CRP normalized to 0.29 mg/dl and the ESR decreased to 60 mm/hr, and the patient had no fever after 57 days of antibiotic therapy. She was directed for follow up at an outpatient clinic.
Ambulatory Care Facilities ; Blood Sedimentation ; C-Reactive Protein ; Emergencies ; Female ; Fever ; Follow-Up Studies ; Humans ; Muscles ; Myositis ; Pelvic Pain ; Pyomyositis ; Sacroiliac Joint ; Sacroiliitis

Early diagnosis and treatment of heterotopic ossification (HO) is essential to the prevention of complications. It is difficult to diagnose HO in its initial phase because non-specific clinical manifestations, laboratory findings and imaging findings of immature HO may mimic other diseases such as cellulitis, osteomyelitis, thrombophlebitis, deep vein thrombosis and local infection with abscess. We experienced two cases of HO, which were misdiagnosed as pyomyositis at first by clinical signs and MRI findings indicating the deep infection; the extensive intramuscular ossification appeared later on. We observed an increase of C-reactive protein and creatine kinase followed by the elevation of alkaline phosphatase with abnormal triphasic bone scan. The trajectory of these biomarkers was analyzed to get more insight into the early stages of HO along with the imaging findings. Although our cases cannot be generalized as typical of immature HO, they clearly demonstrate that the change of specific biomarkers with a careful history taking and physical examination should be noted to detect HO as early as possible while avoiding confusion with other mimicking conditions.
Abscess ; Alkaline Phosphatase ; Biomarkers ; C-Reactive Protein ; Cellulitis ; Creatine Kinase ; Early Diagnosis ; Hydrazines ; Ossification, Heterotopic ; Osteomyelitis ; Physical Examination ; Pyomyositis ; Thrombophlebitis ; Venous Thrombosis

A 63-year-old man with underlying liver cirrhosis was admitted with painful swelling of the right thigh. We identified a non-O1 Vibrio cholerae strain in blood cultures and multiple pyomyositis in the lower limbs. Non-O1 V. cholerae strains have caused several well-studied food-borne outbreaks of gastroenteritis and have been responsible for sporadic cases of otitis media, skin and soft tissue infection, and bacteremia. Skin and soft tissue infection due to non-O1 V. cholerae is rare and is commonly associated with the presence of chronic underlying disease, such as liver cirrhosis, diabetes mellitus, an immunocompromised state, or a hematological malignancy. We report the first case of pyomyositis caused by non-O1 V. cholerae in Korea. Physicians should consider non-O1 V. cholerae strains as a pathogen that can cause pyomyositis.
Bacteremia ; Cholera ; Diabetes Mellitus ; Disease Outbreaks ; Gastroenteritis ; Hematologic Neoplasms ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Lower Extremity ; Middle Aged ; Otitis Media ; Pyomyositis ; Skin ; Soft Tissue Infections ; Sprains and Strains ; Thigh ; Vibrio ; Vibrio cholerae ; Vibrio cholerae non-O1