A 39‐year‐old woman with Lupus, Myositis, and a Recalcitrant Vasculopathy

Pyomyositis in a patient with systemic lupus erythaematosus and a review of the literature

“…CT and MRI commonly confirmed the US results and showed one or more collections with or without adjacent muscular swelling, stranding of subcutaneous fat and skin thickening; this was true in all but four cases 14 18 21 25. Of these cases, 13.0% were invasive (n=3),14 18 21 78.3% were suppurative (n=18)4–10 12 13 15 17 19 20 22–25 and 8.7% were late stage PM (n=2) 11 16. At least 47.8% (n=11/23) met the criteria for sepsis,4 5 11 15 16 19 21 22 24 25 and bacteraemia was evident in 7 of 13 documented blood culture results 5 6 16 17 21 22 24…”

“…The results of the radiographic investigations performed in cases of PM in SLE are illustrated in table 2. CT and MRI commonly confirmed the US results and showed one or more collections with or without adjacent muscular swelling, stranding of subcutaneous fat and skin thickening; this was true in all but four cases 14 18 21 25. Of these cases, 13.0% were invasive (n=3),14 18 21 78.3% were suppurative (n=18)4–10 12 13 15 17 19 20 22–25 and 8.7% were late stage PM (n=2) 11 16.…”

“…Hypocomplementaemia was identified in eight of nine reported cases (including the present case) 4 9 13 14 19 21 23. Of these, seven showed symptoms or signs of active SLE 4 9 13 14 19 21 23…”

“…Laboratory results showed anaemia, with a median haemoglobin level of 10.1 g/dL (range 8.3–11.4 g/dL, n=12) and a WCC>12×10 3 (n=6) or <4×10 3 /µL (n=1) in 41.2% of the cases (n=7/17). Hypocomplementaemia was identified in eight of nine reported cases (including the present case) 4 9 13 14 19 21 23. Of these, seven showed symptoms or signs of active SLE 4 9 13 14 19 21 23…”

Severe thoracic pyomyositis in a patient with systemic lupus erythematosus

“…Timely diagnosis of pyomyositis in patients with SLE is challenging not only because of its non-specific features but also due to its mimicry of SLE flare-up and inflammatory myositis. Chest wall involvement is an uncommon condition and has been identified in only one of 25 reported SLE cases with pyomyositis in the available literature 7–31. Here, we have reported on a case of SLE with a large extent of chest wall pyomyositis, where the patient fully recovered after surgical intervention and antibiotic treatment.…”