Subscapular Abscess Caused by Panton-Valentine Leukocidin-Positive<i>Staphylococcus aureus</i>: An Atypical Presentation

Patel, Kamal; Spowart, Emma; Sochorová, Dana; Diego, Nadia; Mamarelis, Georgios; Sohail, Mohammad Zain

doi:10.1155/2018/8256428

Cited by 6 publications

(15 citation statements)

References 26 publications

(26 reference statements)

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“…The most commonly isolated pathogen from abscesses is Staphylococcus aureus , as was the case in both of our patients. There are several hypothesised aetiologies that can result in abscess formation; the causative organisms may enter the tissue by direct implantation (e.g., a penetrating injury with a contaminated object) [ 6 ] or secondary to trauma [ 2 , 7 ]. They may also enter tissue by direct migration from a location where there is resident flora into an adjacent, normally sterile area because natural barriers have been disrupted (e.g., an area of cellulitis).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intramuscular Abscesses Involving the Rotator Cuff Muscles in Two Cases Presenting During the COVID-19 Pandemic

East¹,

Piper²,

Chan³

2020

Cureus

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Spontaneous abscesses involving the rotator cuff muscles are a rare surgical occurrence. Patients with such abscesses are often initially misdiagnosed or there is a significant diagnostic delay. Herein, we report one case of a spontaneous intramuscular abscess involving the subscapularis muscle and a second case of an abscess involving the supraspinatus muscle. There is a multitude of predisposing risk factors to developing an intramuscular abscess formation, which includes immunodeficiency, trauma, injection drug use, concurrent infection, and malnutrition. The most significant risk factor in our cases was poorly controlled type 2 diabetes mellitus. Poorly controlled diabetes is known to cause impaired clearance of pathogens, predisposing patients to abscess formation. Both patients also delayed presenting to the hospital due to concerns surrounding the coronavirus disease of 2019 (COVID-19) pandemic. We describe the use of a deltoid-pectoral approach to access the subscapular abscess allowing surgical drainage. The supraspinatus abscess was drained by direct incision. We advocate utilising common and familiar approaches with or without arthroscopy where possible. These cases highlight the importance of early imaging in patients presenting with the physiological signs of infection and idiopathic shoulder pain.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Intramuscular Abscesses Involving the Rotator Cuff Muscles in Two Cases Presenting During the COVID-19 Pandemic

East¹,

Piper²,

Chan³

2020

Cureus

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“…Literatürle uyumlu olarak DM tanısı olan hastamızda nazal MRSA izole edildi. Tekrarlayan yüzeyel cilt infeksiyonu hikayesi olan ve künt travma sonrası subskapular apse gelişen diğer bir olguda Panton-Valentine lökosidin (PVL) üreten MSSA'dan bahsedilmiştir [10] . Ancak bizim hastamızda PVL açısından bir araştırma yapılmadı.…”

Section: Discussionunclassified

Nedeni Bilinmeyen Ateş Nedeni: Supskapular Apse

Yapar¹,

Akdoğan²,

Baykam³

2020

FLORA

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A Cause of Unknown Fever: Subscapular Abscess Subscapular abscess is a rare but serious clinical condition due to the small number of cases in the literature requiring early diagnosis and urgent surgical intervention. We aimed to present a case of spontaneous subscapular abscess causing methicillin-resistant Staphylococcus aureus septicemia, which was diagnosed and treated early, without trauma or surgical intervention.

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“…However, careful attention is required since it may hematogenously lead to infection in other organs. To date, only five cases of subscapularis intramuscular abscess diagnosed using CT, MRI, or autopsy findings have been reported (Table 1) [1–5]. Immunocompromised states, such as diabetes [4] or hematoma due to shoulder trauma [3, 5], which are thought to be the sources of infection, have been reported as predisposing conditions.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only five cases of subscapularis intramuscular abscess diagnosed using CT, MRI, or autopsy findings have been reported (Table 1) [1–5]. Immunocompromised states, such as diabetes [4] or hematoma due to shoulder trauma [3, 5], which are thought to be the sources of infection, have been reported as predisposing conditions. However, as in the present case, cases without any underlying disease have also been reported [1, 2].…”

Section: Discussionmentioning

confidence: 99%

“…Treatments for abscesses in the subscapularis muscle primarily focus on antibiotics for the causative microorganism. Surgical drainage was often performed in previous reports [1, 4, 5], but few reports are available on the optimal surgical approach for this abscess type. In approaching the subscapularis muscle belly, after a deltoid-pectoral approach, both an approach from the dorsal side of the subscapularis, dissecting it from the scapula (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Dorsal subscapularis approach for the surgical drainage of subscapularis intramuscular abscess: a case report

Furuhata

Inoue

Kiyota

et al. 2019

BMC Musculoskelet Disord

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Background Abscess formation in the subscapularis muscle is a rare clinical condition. Few reports are available regarding the treatment methods and surgical approaches for subscapularis intramuscular abscesses. Here, we describe a case of subscapularis intramuscular abscess that was treated successfully via surgical drainage using a new approach, the “dorsal subscapularis approach”. Case presentation A 67-year-old woman presented to our hospital with complaints of fever and disturbance of consciousness. Two days prior to visiting our hospital, right shoulder pain and limited range of motion in the shoulder were noted. Cerebrospinal fluid examination and contrast-enhanced computed tomography (CT) imaging on admission revealed a right subscapularis intramuscular abscess with concomitant bacterial meningitis. The patient’s clinical symptoms improved after antibiotic administration for 3 weeks, but the right shoulder pain persisted. Contrast-enhanced CT imaging performed after antibiotic administration revealed an abscess in the right shoulder joint space, in addition to a capsule of the abscess in the right subscapularis muscle. We performed open surgical drainage for the abscess, which had spread from the subscapularis muscle to the glenohumeral joint. Using the deltoid-pectoral approach, we detected exudate and infected granulation tissue in the joint cavity. Furthermore, we separated the dorsal side of the subscapularis muscle from the scapula using a raspatory and detected infected granulation tissue in the subscapularis muscle belly. We performed curettage and washed as much as possible. After surgery, antibiotic administration continued for 2 weeks. The patient’s right shoulder pain subsided and CT performed 2 months after surgery revealed no recurrence of infection. Conclusions The present case indicated that a subscapularis intramuscular abscess could lead to severe concomitant infections of other organs via the hematogenous route. Thus, early detection and treatment are necessary. Moreover, in this case, surgical drainage using a dorsal subscapularis approach was beneficial to treating the abscess, which had spread from the subscapularis muscle to the glenohumeral joint.

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Subscapular Abscess Caused by Panton-Valentine Leukocidin-PositiveStaphylococcus aureus: An Atypical Presentation

Cited by 6 publications

References 26 publications

Spontaneous Intramuscular Abscesses Involving the Rotator Cuff Muscles in Two Cases Presenting During the COVID-19 Pandemic

Spontaneous Intramuscular Abscesses Involving the Rotator Cuff Muscles in Two Cases Presenting During the COVID-19 Pandemic

Nedeni Bilinmeyen Ateş Nedeni: Supskapular Apse

Dorsal subscapularis approach for the surgical drainage of subscapularis intramuscular abscess: a case report

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