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Hany M. Fayed, Hazem Abdel Hafiz
(Department of Internal Medicine, Ahmadi Hospital, Ahmadi, Kuwait)
Med Sci Case Rep 2017; 4:95-100
Tropical pyomyositis (myositis tropicans) is a primary suppurative infection of skeletal muscles, characterized by single or multiple abscesses, usually caused by Staphylococcus aureus. This infectious disease is endemic in tropical areas and sporadic in temperate climates. It occurs mostly in diabetic and immunocompromised patients, such as those with AIDS. The incidence of pyomyositis is increasing worldwide with increasing the prevalence of people infected with HIV.
CASE REPORT: A 45-year-old woman without past medical history of note, attended the hospital with history of back pain radiating to her right lower limb, which started 2 weeks before presentation, with no history of trauma or lifting heavy weights. She was seen 1 week earlier in a polyclinic, and was given pain killers, back support, and a walking stick, but she did not improve, and developed pain in the right hand with mild pain and swelling in the right elbow and low-grade fever.
She has no history of joint pains, mouth ulcers, skin rash, visual disturbance, no chest pain or shortness of breath, no abdominal pain, no headache, nausea, or vomiting, no weight loss, and no recent intramuscular injections.
Clinical assessment showed a woman in a good general condition, fully conscious and oriented, and febrile with a temperature of 38°C. She did not have a skin rash, and results of examination of eyes, chest, and heart were normal.
Neurological examination showed mild proximal weakness (power 4/5) in the right lower limb, with normal reflexes and sensation, and the remainder of neurological examination results were normal.
She had contracture, tenderness, and redness of the right fourth and fifth fingers, painful movement, mild swelling and tenderness in the right elbow, and pain and tenderness over the right gluteal area, lower abdomen, and dorsum of the right foot.
The patient was admitted for investigation. On the next day, she developed urine retention with preserved sacral sensation and no worsening of the right-limb weakness.
CONCLUSIONS: Although pyomyositis is relatively uncommon, it should be considered in patients with muscle pain, fever, and elevated inflammatory markers.