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Primary bacterial intercostal pyomyositis diagnosis: A case report
Hirokazu Toyoshima1, Motoaki Tanigawa2, Chiaki Ishiguro3
1Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Ise, Japan.
Medicine
|May 5, 2023
Summary
Early diagnosis of Staphylococcus aureus pyomyositis is possible with repeated blood cultures, even without abscess formation. This case highlights identifying the pathogen early for effective treatment of bacterial muscle infections.
Area of Science:
- Infectious Diseases
- Medical Microbiology
Background:
- Pyomyositis is a bacterial muscle infection, often caused by Staphylococcus aureus, leading to abscesses.
- Early-stage pyomyositis can present with subtle symptoms, making pathogen identification challenging due to negative initial blood cultures and lack of pus for aspiration.
Observation:
- A 21-year-old immunocompetent male presented with fever and chest/shoulder pain, initially suspected as epidemic myalgia.
- Initial physical exams, ultrasounds, and MRIs showed intercostal muscle inflammation, but repeated blood cultures on days 0 and 8 were negative.
Findings:
- Methicillin-susceptible Staphylococcus aureus (MSSA) was identified on day 15 via blood culture, leading to intravenous cefazolin treatment.
- CT-guided needle aspiration on day 17 confirmed MSSA in the intercostal soft tissue, despite the absence of a visible abscess.
Implications:
- Repeated blood cultures are crucial for diagnosing pyomyositis, especially in non-purulent cases where initial cultures are negative.
- Timely identification of Staphylococcus aureus enables prompt and effective antibiotic treatment, preventing disease progression.
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