Pyomyositis: Are We Missing the Diagnosis?

Abstract

PY is a specific and potentially fatal infection, which is common in our country and must be differentiated from IM. A high index of suspicion and early institution of specific antibiotics followed by operation is therapeutic.

Abdominal Rectus Muscle Pyomyositis: Report of a Case and Review of the Literature

“…Pyomyositis therapy consists of surgical or radiologically-guided drainage of the abscesses, accompanied with broad-spectrum intravenous antibiotic therapy and management of accompanying diseases 10 , 15 , 24 In our case, open drainage of the abscess under local anaesthesia was the therapy of choice, because the abdominal rectus muscle is located immediately beneath the skin, without any other tissues in between. Hyperbaric oxygen therapy (HBOT) in the treatment of pyomyositis, is referred only in one case of iliacus muscle pyomyositis with contribution, as an adjunct to antibiotic therapy, to the favorable outcome of the case.…”

“… 9 The muscles most commonly affected include the extensor femoral muscle group (mainly quadriceps femoris), the outer hip muscles (namely the gluteus muscles) and the inner hip muscles, especially the psoas as well as the iliacus muscle. 5 , 10 The abdominal rectus muscle pyomyositis is very rare and only one other case is referred in medical literature. 6 In our case, this pathological condition could have been caused by hematogenous infection of an abdominal rectus muscle hematoma, as the patient correlated the initial pain at this location with strenuous muscle activity – lifting of a heavy object.…”

“…Toxic shock caused by a non-toxin producing strain of staphylococcus aureus and coma may develop. 10 , 21 …”

“…X-rays are usually unremarkable. The diagnosis is established with an US imaging and verified by a CT scanning, 8 , 10 , 13 which assessed the exact location and extension of the abscess and the condition of the rectus abdominis muscle. Differential diagnosis includes inflammatory abdominal disorders or abdominal tumors, 22 and other disorders of the abdominal wall, 23 such as hematoma, tumors (desmoid, neurinomas, sarcomas) and abscesses due to perforated diverticula.…”

Primary Infective Pyomyositis of the Hip Abductors Presenting as Trochanteric Bursitis

“…Pyomyositis is an uncommon suppurative infection of skeletal muscle. In recent times, it is becoming more prevalent in the context of immunosuppression and diabetes and it is known to show a preponderance for pelvic girdle muscles [1,2,3]. The etiology of pyomyositis is thought to be through hematogenous spread of bacteria, often without a primary local wound or infection [4].…”