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Staphylococcal pyomyositis in patients infected by the human immunodeficiency virus
W A Schwartzman1, M W Lambertus, C A Kennedy
1Department of Medicine, UCLA.
Purpose:
We describe the manifestations of spontaneous staphylococcal pyomyositis in patients infected by the human immunodeficiency virus (HIV).
Patients And Methods:
We present the courses of five previously unreported patients infected by HIV who presented to our medical centers with spontaneous staphylococcal pyomyositis. Additionally, we review all previously reported cases of this entity in HIV-infected patients and discuss its possible pathogenesis and importance in the context of HIV infection.
Results:
All patients presented with gradually developing fever and localized pain and swelling without accompanying leukocytosis. Often only scant evidence of local inflammation was found. None of our patients used intravenous drugs, had a history of trauma, had HIV- or zidovudine-related myositis, or had other conditions known to be associated with serious staphylococcal infections. Two patients studied had normal serum levels of all IgG subclasses. Elevated serum IgE, eosinophilic inflammatory infiltrates, or marked peripheral eosinophilia was observed in two patients.
Conclusions:
Staphylococcal pyomyositis in HIV-infected patients presents in an indolent fashion, which may delay appropriate diagnosis and treatment. Since staphylococcal pyomyositis is infrequently reported in the United States, the development of 14 such cases (five in this series and nine previously reported) among the first 140,000 cases of acquired immunodeficiency syndrome in this country implies that this patient population is predisposed to this infectious complication. The pathogenesis of this entity is uncertain, but it is notable that HIV-infected patients are commonly colonized by Staphylococcus aureus and that neutrophils from HIV-infected patients frequently manifest phagocytic, chemotactic, and oxidative defects, diminished expression of Fc tau RIII (CD16) and CR1, and impaired bactericidal activity against S. aureus.
Insights
Human immunodeficiency virus (HIV) infected patients may develop spontaneous staphylococcal pyomyositis. This condition presents subtly, potentially delaying diagnosis and treatment in this vulnerable population.
Area of Science:
- Infectious Diseases
- Immunology
- Rheumatology
Background:
- Spontaneous staphylococcal pyomyositis is rare in the general population.
- Human immunodeficiency virus (HIV) infection can alter immune responses, potentially increasing susceptibility to certain infections.
- Understanding infectious complications in HIV is crucial for patient management.
Observation:
- Five HIV-infected patients presented with indolent staphylococcal pyomyositis, characterized by gradual fever, pain, and swelling with minimal inflammation.
- These patients lacked typical risk factors for severe staphylococcal infections, such as intravenous drug use or trauma.
- Some patients exhibited atypical immune responses, including normal IgG subclasses, elevated IgE, or peripheral eosinophilia.
Findings:
- HIV-infected individuals appear predisposed to staphylococcal pyomyositis, as evidenced by the number of cases reported in this population.
- The indolent presentation of staphylococcal pyomyositis in HIV patients can mask the severity of the infection.
- Impaired neutrophil function and common Staphylococcus aureus colonization in HIV patients may contribute to this complication.
Implications:
- Early recognition of staphylococcal pyomyositis is vital in HIV-infected patients to ensure timely treatment and prevent complications.
- The predisposition of HIV patients to staphylococcal pyomyositis highlights the need for increased awareness among clinicians.
- Further research into the pathogenesis of staphylococcal pyomyositis in the context of HIV infection is warranted.