Pneumococcal Pyomyositis Secondary to Pneumonia

Abstract

A case of pneumococcal pyomyositis of the brachial and shoulder region is presented. A bacteremic right lower lobe pneumonia was the source of infection. The spread of pneumococci was presumed to be blood-borne, presenting with cellulitis over the right shoulder region, progressing over 5 days to abscess formation in the right biceps muscle and right shoulder joint despite adequate antibiotic treatment.

Two uncommon cases of Pneumococcal pyomyositis

“…S. pneumoniae has rarely been isolated from blood cultures (only 4 of 18 cases) (Collazos et al, 1996;Ejlertsen & Døssing, 1997;Levine et al, 1982;Robertson-Mackay & al-Hillawi, 1993). One of our cases had a positive blood culture, and the other had a positive needle aspiration culture.…”

“…Respiratory infection has been reported to be the main infection associated with pneumococcal pyomyositis, as reported in six cases in the literature (Collazos et al, 1996;Ejlertsen & Døssing, 1997;Granowitz et al, 1992;Nakazato et al, 1999;Oliver et al, 2000;Peetermans et al, 1993), followed by meningitis, which has been reported in five cases of pneumococcal pyomyositis (Levine et al, 1982;Orrison et al, 1977;Robertson-Mackay & al-Hillawi, 1993;Scott & Schmidt, 1989;Simpson et al, 2009).…”

Pneumococcal cellulitis in an immunocompetent adult

“…Therefore, a different pathophysiological mechanism is suggested between cellulitis with S. pneumoniae and cellulitis caused by these other pathogens. In only nine patients including ours, no underlying disease was found or reported, representing a maximum percentage of 20% of patients with pneumococcal cellulitis 5,8–14 . The location of cellulitis was the upper part of the body including face, scalp, chest and upper extremities, and in one case the flank and upper abdomen 5 .…”

Clinical Syndromes Associated with Adult Pneumococcal Cellulitis

“…In one case (6), blood cultures revealed a second pathogen, group A streptococcus. When performed, no common pneumococcal serotype was identified (5,16,17,24). The epidemiology of infection showed that patients with nephrotic syndrome, SLE, or injection drug use were generally younger than patients with diabetes mellitus, ethanol abuse, or hematologic disorders (such as multiple myeloma and macroglobulinemia) (Table II).…”