3 Cases of “Tropical” Pyomyositis in Austrian Children Without a History of Foreign Travel

Introduction

Pyomyositis is a rare purulent infection of striated muscles resulting in localized pain, restriction of movements and tenderness and was first described by Scriba in 1885 (Scriba J., Deutsche Zeit Chir. 1885; 22:497–502). It is more common in tropical areas but has been documented in non-tropical countries among athletes performing vigorous exercise, suggesting the potential role of minor muscle damage in the pathogenesis of the disease (Amoozgar B. et al., Case Rep Infect Dis. 2019;2019:5739714). Other risk factors include HIV-infection, diabetes mellitus, malignancy, cirrhosis, renal insufficiency, organ transplantation, or administration of immunosuppressive agents (Elzohairy M., Orthop Traumatol Surg Res. 2018; 104:397–403). The pathogenesis of the disease is still unknown, but malnutrition, trauma, injection drug use, dental procedures, viral and parasitic infections as well as immunodeficiency or other chronic diseases might have predisposing roles (Verma S., Curr Infect Dis Rep. 2016;18:12).

Staphylococcus aureus is the most common causative agent, particularly community-aquired methicillin resistant Staphylococcus aureus (MRSA) expressing Panton-Valentine-Leukocidin (PVL, Pannaraj P. et al. Clinical Infectious Diseases 2006; 43:953–960) but infections with group A beta-hemolytic streptococci, pseudomonas species, pneumococci and enteric bacilli may occur as well (Burdette S et al., J Infect. 2012;64:507–512).

Differential diagnoses that may mimic this condition include hematoma, appendicitis, perinephric abscess, osteomyelitis, soft tissue sarcoma, deep vein thrombophlebitis and rhabdomyolysis (Elzohairy M., Orthop Traumatol Surg Res. 2018; 104:397–403).

If the infection remains undiagnosed and untreated, intense local pain, as well as systemic findings, including sepsis, multifocal abscesses and shock can occur (Verma S., Curr Infect Dis Rep. 2016;18:12).

In this case report we describe three cases of “tropical” pyomyositis in Austrian children without a history of foreign travel. [Table 1] shows a synopsis of the three cases.

Table 1 Synopsis of the three boys with pyomyositis caused by methicillin sensitive Staph. Aureus.

Pyomyositis	Case 1	Case 2	Case 3
Age	15 y 10 m	3 y 5 m	15 y 1 m
Trauma	Sports injury with additional fracture of the right hallux	Distorsion of the right leg whilst playing	Stumble while hiking
Max. CRP	189 mg/l	56 mg/l	298 mg/l
MRI	Multifocal abscess formations of pelvic muscles and abdominal wall	Abscesses of gastrocnemic muscle, soleus, and popliteal muscles	Abscess of iliac muscle with suspected compartment syndrome
Invasive diagnostic procedures	Ultrasound guided diagnostic drainage of the abdominal wall abscess	Surgical incision of abscess	Biopsy of the right iliac muscle by mini-laparotomy
Antibiotic regimen	Flucloxacillin+Clindamycin	Flucloxacillin	Cefazolin
Duration of antibiotic therapy	3 weeks iv+3 weeks po	25 days iv	2 weeks i.v.+5 days p.o.

Publication History

Article published online:
09 August 2022