Streptococcal pyomyositis in asplenia and underlying connective tissue disease

Area of Science:

• Infectious Diseases
• Rheumatology
• Genetics

Background:

• Pyomyositis is a skeletal muscle infection, typically affecting lower extremities, with primary forms being rare in the United States.
• Staphylococcus aureus is the most frequent cause of pyomyositis; however, Streptococcus pneumoniae is the leading cause of severe bacterial infections in asplenic individuals.
• Immunocompromised status, often associated with conditions like asplenia, increases susceptibility to infections, including S. pneumoniae pyomyositis.

Observation:

• A case report details a 31-year-old man diagnosed with Streptococcus pneumoniae pyomyositis.
• The patient's presentation and hospital course were complicated by an immunocompromised state due to asplenia and an underlying connective tissue disorder, Stickler syndrome.
• While connective tissue diseases like systemic lupus erythematosus and polymyositis are known risk factors for infection, the association with Stickler syndrome is less established.

Findings:

• Streptococcus pneumoniae was identified as the causative agent of pyomyositis in this asplenic patient.
• The patient's underlying Stickler syndrome contributed to his immunocompromised state, complicating the diagnosis and management of the infection.
• This case underscores the importance of considering S. pneumoniae pyomyositis in immunocompromised patients, particularly those with asplenia and connective tissue diseases.

Implications:

• The findings suggest that Stickler syndrome may increase susceptibility to infections like pyomyositis, a risk not widely recognized.
• Pyomyositis, though infrequent (0.2% of US hospital admissions), should be considered in the differential diagnosis for patients presenting with asplenia and connective tissue disorders.
• This case highlights the need for increased awareness of rare infectious complications in patients with complex underlying conditions.