Pyomyositis in the setting of complicated diverticulitis: case report

Area of Science:

• Infectious Diseases
• Gastroenterology
• Surgical Pathology

Background:

• Pyomyositis is traditionally associated with tropical regions but is emerging in temperate zones, potentially due to increased immunosuppression.
• High-dose corticosteroid use, as seen in this patient, is a known risk factor for opportunistic infections and complications.
• Diverticulitis, a common condition, can lead to severe intra-abdominal infections and sepsis.

Observation:

• A 61-year-old male on long-term prednisone presented with respiratory failure and was initially treated for COPD exacerbation.
• Despite antibiotics and surgery for perforated diverticulitis (Hinchey stage 3), the patient developed persistent leukocytosis and bacteremia.
• The patient subsequently developed intramuscular abscesses in the gluteal and vastus lateralis muscles, indicative of pyomyositis.

Findings:

• This case represents the first reported instance of pyomyositis as a complication of perforated diverticulitis.
• The patient's immunosuppression likely contributed to the delayed diagnosis of both diverticulitis and subsequent pyomyositis.
• Prompt surgical drainage of abscesses and continued antibiotic therapy led to clinical improvement and normalization of inflammatory markers.

Implications:

• Clinicians should consider pyomyositis in the differential diagnosis of patients with unexplained deep tissue abscesses, particularly those who are immunocompromised.
• Recognizing pyomyositis as a potential complication of diverticulitis is crucial for timely diagnosis and management, even in non-tropical settings.
• This case underscores the need for vigilance regarding unusual presentations of common diseases in critically ill patients.