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Pyomyositis mimicking osteomyelitis detected by SPET/CT
Zuhair Saleh Abdullah1, Muhammad Umar Khan, Sunil Kumar Kodali
1Department of Nuclear Medicine, Al-Jahra Hospital, PO Box: 363, Abrak Khaitan 83001, Kuwait.
Abstract:
Pyomyositis is a relatively infrequent, sub-acute primary bacterial muscle infection, which due to its non specific clinical findings is unlikely to be early diagnosed especially in diabetic patients. This diagnostic delay may be fatal. Therefore, early diagnosis and prompt treatment are imperative. We present a poorly-controlled diabetic patient who was referred to our Nuclear Medicine department for a bone scan to evaluate osteomyelitis. Routine three-phase-planar-scintigraphy was falsely positive for osteomyelitis in the left fibula, however, single photon emission tomography (SPET/CT) images clearly showed abnormal uptake in the calf muscles rather than the bone with evidence of low-attenuation lesions in these muscles. SPET/CT and magnetic resonance imaging (MRI) provided essential information to the clinicians to consider other diagnoses rather than osteomyelitis. MRI showed inter and intra-muscular collections consistent with multiple abscesses. Based on medical history, SPET/CT and MRI findings, the diagnosis of pyomyositis was established. The patient underwent successfully multiple incision-drainage procedures with subsequent intravenous antibiotic treatment and was discharged after complete recovery. In conclusion we advocate the use of SPET/CT for the detection of pyomyositis.
Insights
Pyomyositis, a bacterial muscle infection, is often missed in diabetics. Single photon emission computed tomography/computed tomography (SPET/CT) aids early diagnosis, improving patient outcomes.
Area of Science:
- Nuclear Medicine
- Radiology
- Infectious Diseases
Background:
- Pyomyositis is a rare bacterial muscle infection often misdiagnosed due to nonspecific symptoms, particularly in diabetic patients.
- Delayed diagnosis of pyomyositis can lead to severe complications or fatality.
- Prompt diagnosis and treatment are crucial for managing pyomyositis.
Observation:
- A diabetic patient initially suspected of osteomyelitis showed false-positive bone scan results.
- Single photon emission computed tomography/computed tomography (SPET/CT) revealed muscle uptake and lesions, not bone involvement.
- Magnetic resonance imaging (MRI) confirmed intramuscular abscesses, aiding in the pyomyositis diagnosis.
Findings:
- SPET/CT effectively differentiated pyomyositis from osteomyelitis by localizing abnormal uptake to the calf muscles.
- MRI provided detailed visualization of inter- and intra-muscular collections consistent with abscesses.
- Combined imaging modalities were essential for establishing the correct diagnosis of pyomyositis.
Implications:
- SPET/CT is a valuable tool for the early and accurate detection of pyomyositis.
- Integrating SPET/CT into diagnostic pathways can improve management of challenging pyomyositis cases.
- This case highlights the importance of advanced imaging in diagnosing atypical presentations of infection in diabetic patients.
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