Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2023; 11(25): 5977-5981
Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.5977
Bilateral thigh pyomyositis in an otherwise healthy middle-aged woman: A case report
Min Cui, Gang Zhang, Na Zhang, Lei Han, Zai-Qi Ma
Min Cui, Gang Zhang, Na Zhang, Lei Han, Department of Pain Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
Zai-Qi Ma, Department of Thoracic Surgery, Qingdao Hiser Hospital Affiliated to Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Cui M contributed to manuscript writing (original draft preparation); Zhang G contributed to conceptualization; Zhang N contributed to visualization; Han L contributed to investigation; Ma ZQ contributed to manuscript writing (reviewing and editing); all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying medical images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zai-Qi Ma, MA, Attending Doctor, Department of Thoracic Surgery, Qingdao Hiser Hospital Affiliated to Qingdao University, No. 4 Renmin Road, Shibei District, Qingdao 266000, Shandong Province, China. 94116845@qq.com
Received: May 23, 2023
Peer-review started: May 23, 2023
First decision: July 17, 2023
Revised: August 1, 2023
Accepted: August 9, 2023
Article in press: August 9, 2023
Published online: September 6, 2023
Processing time: 101 Days and 8.4 Hours
Abstract
BACKGROUND

Pyomyositis generally occurs in otherwise healthy young men. Because this condition is unusual among otherwise healthy women in temperate climates, we present the following case.

CASE SUMMARY

An otherwise healthy 43-year-old woman presented with bilateral pain in her lower extremities and fever. Magnetic resonance imaging (MRI) findings were indicative of myositis with a possible abscess. We initiated empirical antibiotic therapy with ceftriaxone. However, the swelling and pain in her legs persisted even after 7 d of treatment. Contrast MRI revealed multiple pockets of pus in the vastus lateralis and gluteal muscles. We performed needle aspiration of these abscesses with ultrasound guidance and local anesthesia. Upon culturing, the purulent material was positive for Staphylococcus aureus. We diagnosed her with S. aureus-induced pyomyositis of the vastus lateralis muscle and gluteus region. Based on the antibiotic sensitivity report, ceftriaxone was administered for an additional 7 d. By day 15 post-drainage, the patient was able to start walking. Oral antibiotic therapy was continued for 1 wk following her discharge from hospital, after which her symptoms resolved completely.

CONCLUSION

Pyomyositis may present with muscle pain, swelling, and fever. Ultrasound-guided percutaneous puncture and drainage may enable timely diagnosis and treatment.

Keywords: Pyomyositis; Endoscopic ultrasound-guided fine-needle aspiration; Staphylococcus aureus; Climate; Magnetic resonance imaging; Case report

Core Tip: Pyomyositis generally occurs in otherwise healthy young men. We report a case where pyomyositis occurred in an otherwise healthy 43-year-old woman in a temperate climate. This case is unusual because, in temperate regions, pyomyositis usually occurs in immunocompromised patients, such as those with diabetes mellitus. Owing to its rarity in temperate climates and its presentation being characterized by non-specific signs and symptoms, its diagnosis and treatment can be delayed, which can lead to septic shock and death. We hope that our report will help raise awareness and guide the future treatment of patients with pyomyositis.