Traumatic chest wall pyomyositis presenting with mediastinitis

Pyomyositis is an acute bacterial infection of the skeletal muscle that is commonly associated with localized abscess formation. It is estimated that pyomyositis accounts for up to 4% of all hospital admissions throughout Asia, tropical Africa, Oceania and the Caribbean Islands. However, there has been an increasing emergence of pyomyositis in temperate climates and high-income countries. Staphylococcus aureus is the most common organism implicated. Management requires a high index of clinical suspicion, prompt diagnosis and early management to prevent sequalae that can be fatal if left untreated. We describe an interesting case of pyomyositis in an otherwise fit and immunocompetent individual causing mediastinitis; a rare sequalae of the disease. Percutaneous drainage of his left pectoral abscess and a prolonged course of antibiotics provided complete clinical and radiological resolution of the disease despite mediastinal extension. Here we discuss aetiology, associations, pathophysiology and epidemiology of pyomyositis with associated sequalae of the disease.