Primary pyomyositis of the paraspinal muscles: a case report and literature review

Hassan, Freih Odeh Abu; Shannak, Akram

doi:10.1007/s00586-007-0507-7

Cited by 32 publications

(27 citation statements)

References 24 publications

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“…The Open Spine Journal, 2010, Volume 2 19 erector spinae muscles as seen in our case [6,7]. The combination of both these lesions in an immunocompetent person is extremely rare.…”

Section: Pyogenic Epidural Abscess With Primary Erector Spinae Pyomyomentioning

confidence: 81%

Pyogenic Epidural Abscess with Primary Erector Spinae Pyomyositis - Case Report~!2010-04-29~!2010-05-23~!2010-08-02~!

Srinivasan¹

2010

TOSPINEJ

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Abstract:Introduction: Pyogenic epidural abscess associated with primary pyomyositis of erector spinae in an immunocompetent individual is extremely rare. Here we report such a case which has been successfully managed. Materials and Methods:A 26 year old man presented with severe pain in the low back region radiating to both the legs of 3 weeks duration. He was initially suspected to have prolapsed lumbar disc and treated conservatively without relief of symptoms. He had low grade fever on admission with no obvious systemic source of sepsis. Examination revealed only a positive straight leg raising test on both the sides with paravertebral muscle spasm and tenderness over the lumbar region without any other neurological deficit.Results: Laboratory results showed leucocytosis, neutrophilia, elevated erythrocyte sedimentation rate and C-reactive protein. Magnetic resonance imaging (MRI) of the spine with contrast revealed an extensive L3 -S1 epidural abscess with multiple loculated collection of pus in the erector spinae muscles suggestive of pyomyositis. Abscess from the lumbar paravertebral muscles was drained, L5 bilateral laminectomy was performed and extradural abscess was completely evacuated. Pain was completely relieved in the immediate post operative period. Culture revealed growth of staphylococcus aureus which was sensitive to most of the antibiotics except oxacillin. Patient was treated with intravenous vancomycin for 3 weeks which was followed by oral linezolid for 3 weeks combined with oral ofloxacin for 6 weeks. Follow up spinal MRI scan with contrast performed after 6 months was normal. There was no recurrence of symptoms even at the end of 7 months. Conclusion:Pyogenic spinal infection associated with paraspinal muscle abscess must always be considered when back pain with leg pain is associated with fever, leucocytosis and elevated ESR. Staphylococcus aureus is the most common pathogen in these cases. Hematogenous spread of infection through the venous communication between the external vertebral venous plexus with the internal vertebral veins, resulting in simultaneous abscess formation in both the sites is the probable pathogenesis in our case. Early surgical drainage of the abscess from both the sites, with concurrent use of antibiotic therapy for 6 weeks based upon the sensitivity of the organism is required to achieve an excellent outcome.

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“…The Open Spine Journal, 2010, Volume 2 19 erector spinae muscles as seen in our case [6,7]. The combination of both these lesions in an immunocompetent person is extremely rare.…”

Section: Pyogenic Epidural Abscess With Primary Erector Spinae Pyomyomentioning

confidence: 81%

Pyogenic Epidural Abscess with Primary Erector Spinae Pyomyositis - Case Report~!2010-04-29~!2010-05-23~!2010-08-02~!

Srinivasan¹

2010

TOSPINEJ

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“…It was classically considered an infection of the tropics affecting healthy children and adults, but since the 1970s, with the advent of routine diagnostic imaging, its recognition has been increasing in other parts of the world as well 1. Due to the likely influence of industrialisation and better living conditions, this disease has increasingly been described as a disease among the immunocompromised patients, such as those with HIV, diabetes, malignancy or other debilitating conditions 2…”

Section: Discussionmentioning

confidence: 99%

Case of acute paraspinal pyomyositis in an elderly diabetic secondary to spread from urinary tract infection

Unnikrishnan¹,

Delacruz

Saha

et al. 2018

BMJ Case Reports

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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 (Group B Streptococcus) and the patient was treated with 6-week course of intravenous antibiotics.

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“…Trauma is a risk factor because it alters the local muscle tissue structure that then acts as a sanctuary for bacteria 11 . Staphylococcus aureus is the causative pathogen in 70–95% of cases,13 while group A Streptococcus is the second commonest organism 14. Other pathogens have very rarely been reported 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Features of infection such as fever, elevated inflammatory markers (WCC, CRP, erythrocyte sedimentation rate (ESR)) and bacteraemia, are often present in pyomyositis but absent in myositis 6 9 13. MRI is considered the gold standard imaging modality to diagnose pyomyositis and will identify diffuse muscle inflammation, reactive lymphadenopathy and abscesses, if they have formed 18.…”

Section: Discussionmentioning

confidence: 99%

Acquired torticollis due to primary pyomyositis of the paraspinal muscles in an 11-year-old boy

et al. 2016

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Torticollis is characterised by tilting and rotation of the cervical spine in opposite directions. Causes can be congenital or acquired. Primary pyomyositis is a rare subacute deep bacterial infection of skeletal muscles that typically affects individuals under 20 years of age from tropical countries. Infrequently, pyomyositis occurs in individuals from temperate regions, usually in immunocompromised adults, and this is defined as secondary pyomyositis. We report a case of acquired torticollis due to primary pyomyositis of the paraspinal muscles in a previously healthy boy from the UK. A prolonged course of antibiotics and physiotherapy led to a complete resolution of his illness. We review how to differentiate pyomyositis from focal myositis, a more common inflammatory muscular cause of acquired torticollis.

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Primary pyomyositis of the paraspinal muscles: a case report and literature review

Cited by 32 publications

References 24 publications

Pyogenic Epidural Abscess with Primary Erector Spinae Pyomyositis - Case Report~!2010-04-29~!2010-05-23~!2010-08-02~!

Pyogenic Epidural Abscess with Primary Erector Spinae Pyomyositis - Case Report~!2010-04-29~!2010-05-23~!2010-08-02~!

Case of acute paraspinal pyomyositis in an elderly diabetic secondary to spread from urinary tract infection

Acquired torticollis due to primary pyomyositis of the paraspinal muscles in an 11-year-old boy

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