RESUMEN
An unusual case of an immunocompetent young adult with osteomyelitis and pyomyositis of his right thigh is presented. Despite the absence of typical clinical signs, a high index of suspicion and 16S RNA PCR led to an early diagnosis of Fusobacterium infection and subsequent successful multidisciplinary treatment.
Asunto(s)
Infecciones por Fusobacterium/diagnóstico , Osteomielitis/diagnóstico , Piomiositis/diagnóstico , Infecciones por Fusobacterium/inmunología , Humanos , Inmunocompetencia , Masculino , Osteomielitis/inmunología , Piomiositis/inmunología , Muslo , Adulto JovenAsunto(s)
Granulomatosis con Poliangitis/tratamiento farmacológico , Inmunosupresores/efectos adversos , Nocardiosis/microbiología , Nocardia/patogenicidad , Infecciones Oportunistas/microbiología , Piomiositis/microbiología , Antibacterianos/uso terapéutico , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/inmunología , Humanos , Huésped Inmunocomprometido , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nocardia/efectos de los fármacos , Nocardia/inmunología , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Piomiositis/diagnóstico , Piomiositis/tratamiento farmacológico , Piomiositis/inmunología , Resultado del TratamientoRESUMEN
Musculoskeletal tuberculosis (TB) occurs in only 3% of patients with TB while tuberculous pyomyositis is rare. It usually affects immunocompromised or patients with underlying comorbidities. We present a case of tuberculous pyomyositis in a 85-year-old Caucasian patient with rheumatoid arthritis (RA) treated with steroids and anakinra. The patient presented with fever as well as redness, swelling and induration on the lateral side of the hip and thigh. Under ultrasound guidance fluid collection of the thigh was aspirated. Polymerase chain reaction (PCR) and cultures of the fluid were positive for Mycobacterium TB. The patient underwent bronchoscopy. PCR and cultures from the bronchoalveolar lavage were also positive for Mycobacterium TB. The patient was treated with anti TB treatment with amelioration of the inflammation in the hip and thigh. This is the first reported case of tuberculous pyomyositis in a RA patient treated with anakinra.
Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Proteína Antagonista del Receptor de Interleucina 1/efectos adversos , Infecciones Oportunistas/inducido químicamente , Piomiositis/inducido químicamente , Tuberculosis/inducido químicamente , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/inmunología , Humanos , Huésped Inmunocomprometido , Imagen por Resonancia Magnética , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Piomiositis/diagnóstico , Piomiositis/tratamiento farmacológico , Piomiositis/inmunología , Piomiositis/microbiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/inmunología , Tuberculosis/microbiologíaRESUMEN
In conclusion, our case highlights the unusual presentation of tropical pyomyositis in a temperate environment. It is important to consider this diagnosis in immunocompromised hosts, even in those with vague complaints such as muscle pain or erythema. The patient's immunocompromised state as well as the rarity of tropical pyomyositis outside of a tropical country led to a late diagnosis. Tropical pyomyositis is a potentially life threatening disease, but if recognized and treated early, the prognosis is good.
Asunto(s)
Absceso/inmunología , Enfermedad de la Arteria Coronaria/inmunología , Diabetes Mellitus Tipo 2/inmunología , Huésped Inmunocomprometido/inmunología , Síndromes Mielodisplásicos/inmunología , Piomiositis/inmunología , Músculo Cuádriceps/patología , Infecciones Estafilocócicas/inmunología , Absceso/diagnóstico , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Piomiositis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureusRESUMEN
Pyomyositis remains poorly documented in tropical Latin America. We therefore performed a retrospective review of cases admitted to a hospital in the upper Negro river basin during 2002-2006. Seasonality was assessed by the cosinor model and independent predictors of outcome were identified by logistic regression. Determinants of time-to-fever resolution were analysed using Cox regression. No seasonal trend was observed (p=0.284) among 82 hospitalised patients. The disease predominated in young males and the most commonly affected part of the body was the lower limb (68 [63.5%] out of 107 lesions). Staphylococcus aureus was the only identified infecting organism (18 of 20 culture results, 90%). Complications occurred in 17 patients (20.7%) and the case fatality rate was 2.4%. Children were more likely to present with eosinophilia than adults (OR= 4.20, 95% CI 1.08-16.32, p=0.048), but no other significant differences regarding clinical presentation and outcomes were observed. The time-to-fever resolution was the only independent determinant of poor outcome (OR=1.52, 95% CI 1.22-1.92, p<0.001) and was significantly longer in patients treated with combined antibiotic therapy than in those treated with single antibiotics (HR=0.523, 95% CI 0.296-0.926, p=0.026). Further studies to determine the best antibiotic therapy modality for the treatment of pyomyositis are required.
Asunto(s)
Anemia/microbiología , Antibacterianos/uso terapéutico , Fiebre/microbiología , Piomiositis/complicaciones , Piomiositis/epidemiología , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/patogenicidad , Adolescente , Adulto , Distribución por Edad , Anemia/epidemiología , Anemia/inmunología , Brasil/epidemiología , Niño , Preescolar , Femenino , Fiebre/epidemiología , Fiebre/inmunología , Humanos , Huésped Inmunocomprometido/inmunología , Modelos Logísticos , Masculino , Piomiositis/inmunología , Piomiositis/microbiología , Estudios Retrospectivos , Ríos/microbiología , Estaciones del Año , Distribución por Sexo , Infecciones Estafilocócicas/inmunología , Infecciones Estafilocócicas/microbiología , Factores de Tiempo , Adulto JovenRESUMEN
We report a case of pyomyositis in a 59 year-old immunocompetent male patient caused by methicillin-susceptible Staphylococcus aureus. A CT scan of the chest demonstrated a lesion of the pectoral muscles. The patient was treated with surgical drainage and cephalexin. Pyomyositis is a rare and potentially serious infection that requires early recognition and prompt treatment.
Asunto(s)
Inmunocompetencia , Piomiositis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus , Humanos , Masculino , Persona de Mediana Edad , Piomiositis/inmunología , Infecciones Estafilocócicas/inmunologíaRESUMEN
We report a case of pyomyositis in a 59 year-old immunocompetent male patient caused by methicillin-susceptible Staphylococcus aureus. A CT scan of the chest demonstrated a lesion of the pectoral muscles. The patient was treated with surgical drainage and cephalexin. Pyomyositis is a rare and potentially serious infection that requires early recognition and prompt treatment.
Se presenta un caso de piomiositis en un varón de 59 años, inmunocompetente, producida por Staphylococcus aureus sensible a meticilina, afectando los músculos pectorales del hemitórax derecho. Fue tratado con drenaje quirúrgico y cefalexina. La piomiositis es una infección infrecuente y potencialmente seria que requiere de un reconocimiento temprano y tratamiento oportuno.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Inmunocompetencia , Piomiositis/diagnóstico , Staphylococcus aureus , Infecciones Estafilocócicas/diagnóstico , Piomiositis/inmunología , Infecciones Estafilocócicas/inmunologíaRESUMEN
Pyomyositis is a suppurative infection of the skeletal muscle; it mainly occurs in immunocompromised patients or, exceptionally, in immunocompetent patients in tropical or other areas. We present a 24-year-old immunocompetent lady with bilateral thigh myalgia and fever. Upon investigation, extensive multifocal bilateral fluid collections involving the extensor muscles of both thighs were demonstrated. Pus aspirate from the involved muscles proved the presence of Staphylococcus aureus. Incision and drainage of the involved muscles were performed with successful and complete recovery.
Asunto(s)
Piomiositis/inmunología , Infecciones Estafilocócicas/inmunología , Femenino , Humanos , Inmunocompetencia , Jordania , Piomiositis/diagnóstico por imagen , Piomiositis/microbiología , Radiografía , Adulto JovenRESUMEN
Pyomyositis is a purulent infection of skeletal muscles that arise from hematogenous spread associated with abscess formation. Most often caused by Staphylococcus aureus in more than 90-95% of cases but other rare organisms can cause this infection. Herein we report a rare case of strenotrophomonas maltophilia as a cause of pyomyositis which is a rare occurrence, especially in immunocompetent adults. Strenotrophomonas is a multidrug-resistant aerobic non-fermentative, non-sporulating, gram-negative bacillus which usually produces nosocomial infections, but community-acquired infections are also rarely reported. This a first case report of strenotrophomonas maltophilia causing pyomyositis in an immunocompetent adult.
Asunto(s)
Infecciones por Bacterias Gramnegativas/microbiología , Piomiositis/microbiología , Stenotrophomonas maltophilia/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/inmunología , Humanos , Inmunocompetencia , India , Masculino , Piomiositis/tratamiento farmacológico , Piomiositis/inmunología , Resultado del TratamientoRESUMEN
Immune reconstitution inflammatory syndrome is recognized as a paradoxical worsening of preexisting or smoldering opportunistic infections in patients with human immunodeficiency virus on highly active antiretroviral therapy because of the recuperating of immune system. We report a 42-year-old man on antiretroviral therapy with silent mycobacterium tuberculosis pyomyositis presenting with characteristic clinical and imaging features of immune reconstitution inflammatory syndrome. Because tuberculosis pyomyositis is less recognized and may be easily overlooked in terms of protean manifestations in extrapulmonary tuberculosis spreading, such mycobacterial infection can bring about substantial morbidity and even mortality during the immune recovery phase. The worldwide incidence of human immunodeficiency virus combined with tuberculosis infection is skyrocketing; therefore, emergency physicians must keep a heightened awareness and proficiency of this emerging culprit to obviate unnecessary intervention, preserve organ function, and achieve better outcomes.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , VIH-1 , Síndrome Inflamatorio de Reconstitución Inmune/inmunología , Piomiositis/inmunología , Piomiositis/microbiología , Tuberculosis/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Piomiositis/terapia , Tuberculosis/terapiaRESUMEN
Staphylococcus epidermidis is a common cause of infections associated with prosthetic devices and immunocompromised patients. Spontaneous pyomyositis due to the above pathogen is very uncommon. Kikuchi-Fujimoto disease (KFD) is a subacute necrotizing lymphadenitis, first described in Japan. A T cell-mediated hyperimmune response to various pathogens in a genetically susceptible individual has been primarily been considered in its pathogenesis. We report a patient who developed spontaneous pyomyositis caused by S. epidermidis concurrently with KFD, and discuss the possibility of S. epidermidis infection being the stimulant of KFD.
Asunto(s)
Linfadenitis Necrotizante Histiocítica/diagnóstico , Piomiositis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Staphylococcus epidermidis , Antibacterianos/uso terapéutico , Femenino , Linfadenitis Necrotizante Histiocítica/tratamiento farmacológico , Linfadenitis Necrotizante Histiocítica/inmunología , Humanos , Persona de Mediana Edad , Piomiositis/tratamiento farmacológico , Piomiositis/inmunología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/inmunología , Staphylococcus epidermidis/inmunologíaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones por VIH/inmunología , Huésped Inmunocomprometido , Piomiositis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Clima , Infecciones por VIH/microbiología , Humanos , Piomiositis/inmunologíaRESUMEN
Pyomyositis is a musculoskeletal infection with formation of an intramuscular abscess. Endemic in tropical climates, it is being reported with increasing frequency in temperate climates such as the United States. The most common causative organism is Staphylococcus aureus, present in greater than 90% of reported cases. Risk factors include underlying chronic illness, malnutrition, immunocompromised state, and muscle trauma. We present a case in which Streptococcus agalactae was the causative agent of myositis in a child with a history of perinatally derived human immunodeficiency virus infection.