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Fulminant Necrotizing Pyomyositis Tropicans

Snehasis Das1, Oseen Shaikh1, Naveen Kumar Gaur1

  • 1Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.

Cureus
|March 7, 2022
PubMed

Insights

Fulminant necrotizing pyomyositis, a rare invasive muscle infection, occurred in an immunocompetent teen. This case, caused by Escherichia coli, highlights a unique presentation leading to fatal septic shock.

Area of Science:

  • Infectious Diseases
  • Bacteriology
  • Critical Care Medicine

Background:

  • Pyomyositis tropicans is typically a bacterial infection of striated muscle, often caused by Staphylococcus aureus or Streptococcus.
  • It predominantly affects immunocompromised individuals, presenting as a purulent invasive process.

Observation:

  • A 16-year-old immunocompetent patient presented with symptoms suggestive of extensive intramuscular abdominal wall abscess.
  • Imaging confirmed significant abscess formation, necessitating surgical intervention on the lateral thoracic wall.

Findings:

  • The causative organism identified through cultures was Escherichia coli, an unusual pathogen for this presentation.
  • Despite surgical debridement, the patient developed irreversible septic shock, resulting in a fatality.

Implications:

  • This case represents the first reported instance of fulminant necrotizing pyomyositis in an immunocompetent host due to Escherichia coli.
  • It underscores the potential for severe, rapidly progressing infections even in immunocompetent individuals and expands the known spectrum of pyomyositis tropicans.
  • Highlights the critical need for prompt diagnosis and aggressive management of invasive bacterial infections.
Keywords:
antibioticsdebridementimmunocompetentpyomyositisseptic shock

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