Pyomyositis associated with hematological malignancy: case report and review of the literature

Abstract

Pyomyositis occurs most commonly in patients with various immunosuppressive diseases. However, the association of pyomyositis with an underlying hematological malignancy has not been reviewed. We present herein a relevant case and also review the available literature regarding the association of non-tropical pyomyositis and hematological malignancies. The case patient, a 46-year old female, had non-tropical pyomyositis of the iliopsoas and obturator muscles due to Staphylococcus aureus and underlying Hodgkin's disease. Forty-four patients with pyomyositis and an associated hematological malignant disease have been reported in the literature. The most common types of hematological oncology diseases found were acute lymphocytic leukemia (present in 11/44 patients (25%)) and multiple myeloma (7/44 patients (15.9%)). Staphylococcus aureus was the most common cause of pyomyositis (26 out of 44 patients (59.1%)). The muscles of the thigh were most commonly affected (18/44 patients (40.9%)). Medical therapy with antibiotics and surgical drainage were employed in 25/44 (56.8%) of the patients. Thirty out of 44 (68.2%) of the patients had a successful outcome. Death occurred in 5/44 (11.4%) patients. In cases of pyomyositis, the physician should consider an underlying hematological malignancy.

Bacterial, Fungal, Parasitic, and Viral Myositis

“…Cases in the United States often occur among immunocompromised persons; a study found that 48% of pyomyositis cases among human immunodeficiency virus (HIV)-uninfected persons had at least one underlying medical condition (49). The rising incidence rates of pyomyositis cases within the United States are likely the result of increasing numbers of immunocompromised patients, including cancer patients receiving chemotherapy and those with rheumatologic conditions taking immunomodulatory agents, in addition to those with HIV infection, diabetes mellitus, and liver disease (49,72,246).…”

Escherichia coli sepsis and pyomyositis following allogeneic stem cell transplant

“…The infection occurs predominantly in the tropical regions of the world but to a much lesser extent in the temperate zones where it is often associated with immunocompromised or other serious underlying conditions. Most cases of pyomyositis in both tropical and temperate zones are caused by grampositive organisms especially Staphylococcus aureus [1][2][3][4][5]. Non staphylococcal pathogens are more typical in temperate regions like in our patient.…”

“…Even though E. coli pyomyositis in a hematologic malignancy host seems to favor the calf, as noted in some reports [2,6], this has not been the case in some other reports with E. coli as the sole pathogen [3,7,8]. In a report of 44 patients with pyomyositis associated with hematological malignancies, none of them was attributable to E. coli and calf or leg involvement was reported in only six patients (13.6%) [1]. E. coli pyomyositis in the immunocompromised or patients with hematological malignancies has an associated mortality rate up to 33% [1, 4.6].…”

“…Traditionally, most cases of pyomyositis are attributable to Staphylococcus aureus in both normal and immunocompromised hosts [1]. Despite this observation, pyomyositis in the transplant patient and similar immunocompromised hosts often have uncharacteristic presentations and are sometimes associated with the 'unlikely' pathogen [2].…”

Pyomyositis and bacteremia due to Staphylococcus aureus as onset of acute promyelocytic leukemia

“…1 Classically, pyomyositis has been described in tropical countries, associated with repetitive trauma in malnourished people, but in recent years it has been reported in nontropical areas, particularly in immunocompromised hosts. 2 It is not infrequent that more than one muscle group is affected.…”