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Primary pyomyositis in an infant following one-day afebrile upper limb monoplegia
Yusuke Takezawa1, Soh Niitsuma1, Sayaka Kawashima1
1Department of Pediatrics, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi, Japan.
Insights
Pyomyositis, a bacterial skeletal muscle infection, is rare in healthy infants. This case highlights bacterial myositis presenting as limb paralysis, emphasizing the need to consider infection even without fever in infants.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
Background:
- Pyomyositis is a bacterial infection of skeletal muscles, typically presenting with fever, swelling, and pain.
- Data on pyomyositis in healthy infants is limited.
- This report details a rare case in a one-month-old infant.
Observation:
- An infant presented with sudden left forearm paralysis, initially suspected as intracranial pathology.
- The infant later developed fever and left forearm swelling.
- Magnetic resonance imaging confirmed inflammation in the forearm muscles.
Findings:
- The infant was diagnosed with bacterial myositis (pyomyositis).
- Treatment involved intravenous and oral antibiotics.
- The infant recovered fully without sequelae or relapse.
Implications:
- This case underscores that bacterial infection should be suspected in infants presenting with limb paralysis, even without initial fever.
- Early diagnosis and prompt antibiotic treatment are crucial for favorable outcomes in infant pyomyositis.
- Highlights the importance of considering pyomyositis in the differential diagnosis of pediatric limb paralysis.
Abstract:
Background : Pyomyositis is a subacute bacterial infection of the skeletal muscles. Its most common features are fever, muscle swelling, and focal pain. There have been insufficient data regarding pyomyositis in healthy infants. Case report : A one-month-old boy presented with an impairment of his left arm movement. He was well-nourished and not under any apparent distress. His vital signs were within the normal limits but neurological examination revealed left forearm paralysis. Physical examination showed no abnormal findings in the region from the left shoulder joint to the fingertips. Considering these factors, an intracranial pathology was initially suspected. However, he developed a fever, regular tachycardia, and swelling in the left forearm. Magnetic resonance imaging revealed inflammation in the left forearm muscles. He was diagnosed with bacterial myositis and started on intravenous antibiotics. On the 17th day, he was discharged with oral antibiotic treatment, which was completed over 25 days without any sequelae nor relapse. Conclusion : Here we report the case of Japanese primary pyomyositis following one-day afebrile upper limb monoplegia in an infant. Even when infants exhibit afebrile symptoms, a bacterial infection should be suspected. J. Med. Invest. 68 : 372-375, August, 2021.
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