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Published on: March 2, 2020
The piriformis abscess: a case-based review
Mohammadreza Salehi1, Fereshteh Ghiasvand2, Mohammad Mehdi Feizabadi3
1Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Abstract:
This study reports a 43 years-old man diagnosed with piriformis pyomyositis. A literature review was conducted by searching MEDLINE via Pubmed for English language case reports, published from 8th December 2019 to 20th January 2020. Patients' symptoms, laboratory tests, imaging, treatment, and other comorbidities were evaluated. Thirty-two cases diagnosed with piriformis pyomyositis, of which 21 patients developed piriformis abscess (including one new patient added by us) of which 52.4% were female, and the mean age was 26.98 ± 17.5. The most common manifestations were fever, lower back pain, and limited ambulation with increased ESR, CRP, or leukocytosis. Staphylococcus aureus was the most prevalent (57.14%) pathogen isolated. The authors suggested gynecologic manipulations, muscle overuse, and other co-infections as probable risk factors. However, we fail to find any association between these factors and abscess formation (p>0.05). Piriformis abscess should be regarded as a probable diagnosis in patients with gluteal pain, fever, and limited ambulation that have raised inflammatory markers or leukocytosis. MRI and CT scans are beneficial in diagnosing pyomyositis in early-stage. Full recovery is expected with timely antibiotic and surgical treatments.
Insights
Piriformis pyomyositis, often presenting with fever and pain, requires prompt diagnosis. Early imaging and treatment with antibiotics and surgery lead to full recovery, even with abscess formation.
Area of Science:
- Medical Case Reports
- Infectious Diseases
- Musculoskeletal Disorders
Background:
- Piriformis pyomyositis is a rare condition involving inflammation and infection of the piriformis muscle.
- Literature review focused on case reports to understand clinical presentation, risk factors, and outcomes.
Observation:
- A review of 32 piriformis pyomyositis cases, including 21 with abscesses, revealed common symptoms like fever, gluteal pain, and limited ambulation.
- Elevated inflammatory markers (ESR, CRP) and leukocytosis were frequently observed.
- Staphylococcus aureus was the most common pathogen identified.
Findings:
- No significant association was found between suggested risk factors (gynecologic manipulations, muscle overuse, co-infections) and piriformis abscess formation.
- Piriformis abscess should be considered in patients with gluteal pain, fever, and limited mobility, especially with elevated inflammatory markers.
Implications:
- Early diagnosis using MRI and CT scans is crucial for effective management.
- Timely antibiotic and surgical interventions are essential for achieving full recovery from piriformis pyomyositis and abscess.
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