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Wentao L, Shuxia X, Guoxing Z, Qiaoping C, Peiran C, Angela W, Meirong L, Songchao Y, Peiying F. Diagnosis of multiple tuberculous muscle abscesses in a patient with systemic lupus erythematosus by metagenomic next-generation sequencing- a case report and literature review. BMC Infect Dis 2024; 24:284. [PMID: 38438834 PMCID: PMC10913444 DOI: 10.1186/s12879-024-09179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Early diagnosis of muscular tuberculosis (TB) without coexistent active skeletal involvement is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of muscular TB, we present a case of multiple tuberculous muscle abscesses in a systemic lupus erythematosus (SLE) female, but without pulmonary tuberculosis (PTB), in order to increase awareness of and stress the need of early detection of muscular TB. CASE PRESENTATION A 44-year-old woman with a 6-year history of SLE who had been treated with methylprednisolone for a long time complained of erythema on her trunk and extremities for five months, along with edema and myalgia for two months, and fever for one month. The patient was first misdiagnosed as SLE overlap dermatomyositis. However, an ultrasound-guided drainage of muscle abscesses revealed positive acid-fast staining combined with positive deoxyribonucleic acid fragment of Mycobacterium tuberculosis using metagenomic next-generation sequencing (mNGS). The patient was cured and released following standard anti-tuberculosis medication, local puncture drainage, and an intravitreal injection of streptomycin. Literature search found only 19 cases of tuberculous muscle abscesses occurring in the extremities reported from 1999 to 2023. CONCLUSIONS Extrapulmonary TB with predominantly muscle involvement is rare and with no specific clinical presentation. Muscular tuberculosis may be disdiagnosed for dermatomyositis due to the high muscle enzyme levels, delaying diagnosis and treatment. mNGS technology is helpful in the early and rapid diagnosis of muscular TB. On the basis of traditional anti-tuberculosis treatment, an ultrasound-guided percutaneous puncture drainage and intracavitary injection of streptomycin for the treatment of tuberculous muscle abscess is easy to operate, safe and effective, which is worthy of clinical popularization and application.
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Affiliation(s)
- Liu Wentao
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xie Shuxia
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhu Guoxing
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chen Qiaoping
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chen Peiran
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wu Angela
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li Meirong
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yin Songchao
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feng Peiying
- Department of Dermatology, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
- Department of Allergy, 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Dharmshaktu GS, Dharmshaktu IS, Pangtey T. Pyomyositis involving the scapular muscles: A case series. J Family Med Prim Care 2023; 12:1730-1734. [PMID: 37767417 PMCID: PMC10521815 DOI: 10.4103/jfmpc.jfmpc_253_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 09/29/2023] Open
Abstract
Pyomyositis or tropical pyomyositis is an uncommon infection of skeletal muscle that may be primary or secondary. Primary type has bacterial aetiology, and Staphylococcus aureus is associated in most cases. The diagnosis requires high index of suspicion and careful assessment of radiological investigations. Diagnosis often requires magnetic resonance imaging (MRI) for better delineation of the disease process, associated site involvement and exclusion of related conditions. Evacuation of pus coupled with appropriate antibiotic therapy is the mainstay and curative in most cases. Caution, however, is required due to increased morbidity, protracted course of recovery and mortality in few cases. The association with comorbidities including immunocompromised status compounds the problem. We describe our experience with this condition in a series of five cases (four male and one female) with diverse involvement of scapular muscle. All cases had primary pyomyositis except one case secondary to shoulder joint tuberculosis. Right side was involved in three and left in two cases. Infraspinatus was commonly involved, and one case had extensive involvement around scapula. All cases were managed by one or multiple aspiration, except one managed with open surgical drainage. The outcome was good in all cases with no recurrence or complication noted in their respective follow-up. Primary care centres may play important role in the early diagnosis of this condition with clinical evaluation and judicious use of imaging. Cases with severe involvement or those requiring advanced procedures may be referred to higher centres as per the requirement. Most of the times, timely diagnosis, antibiotic therapy and drainage of the pus is required and may also be performed in the primary care level through a standard protocol.
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Affiliation(s)
- Ganesh S. Dharmshaktu
- Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
| | - Ishwar S. Dharmshaktu
- Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
| | - Tanuja Pangtey
- Department of Pathology and Blood Bank, Government Medical College, Haldwani, Uttarakhand, India
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Kim JH, Lee JS, Choi BY, Cheon YH, Yoo SJ, Ju JH, Shin K, Kim ES, Baek HJ, Park W, Song YW, Hong WH, Lee YJ. Isolated Tuberculous Myositis: A Systematic Review and Multicenter Cases. JOURNAL OF RHEUMATIC DISEASES 2022; 29:243-253. [PMID: 37476423 PMCID: PMC10351410 DOI: 10.4078/jrd.22.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 07/22/2023]
Abstract
Objective To investigate the clinical features and associated underlying conditions of isolated tuberculous myositis (ITBM), a rare extrapulmonary tuberculosis (TB). Methods A systematic literature search and a multicenter survey were performed using a triangulation strategy. Data from the identified ITBM cases were extracted and analyzed to determine the underlying conditions, clinical presentations, treatments, and outcomes. Results Based on the systematic review, we identified 58 ITBM, including 9 pediatric, cases in the literature published from 1981 to 2021 25 (43.1%) immunocompromised and 33 (56.9%) non-immunocompromised patients. Immunocompromised cases had a significant shorter symptom duration (median 30.0 vs. 75.0 days) and a higher prevalence of multilocular involvement (20.8% vs. 0%). Among 24 immunocompromised adult patients, dermatomyositis/polymyositis (DM/PM; n=10, 41.7%) were the most common underlying diseases in adults with ITBM identified in the systematic review. Over the past 20 years, 11 Korean adults with ITBM were identified in the multicenter survey. Of 7 immunocompromised cases, two (28.6%) were DM/PM patients. TB death rate of immunocompromised patients was 0.0% and 5/23 (21.7%) in the pediatric and adult ITBM cases identified in the systematic review, respectively, and 3/7 (42.9%) in survey-identified ITBM cases. Conclusion ITBM has a unique clinical presentation including fever, tenderness, local swelling, overlying erythema, abscess formation and was associated with a grave outcome, especially in immunocompromised hosts. DM/PM was a highly prevalent underlying disease in both systematic review-identified and survey-identified immunocompromised ITBM patients.
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Affiliation(s)
- Ji Hyoun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jeong Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Byoong Yong Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Yun-Hong Cheon
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Su-Jin Yoo
- Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Won Park
- Medicine/Rheumatology, School of Medicine, Inha University, Incheon, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Woi-Hyun Hong
- College of Medicine and Medical Research Information Center (MedRIC), Chungbuk National University, Cheongju, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Kuo YN, Lai CS, Chen YH, Kuo-Lung L. Severe thoracic pyomyositis in a patient with systemic lupus erythematosus. BMJ Case Rep 2022; 15:15/3/e246484. [PMID: 35260400 PMCID: PMC8905888 DOI: 10.1136/bcr-2021-246484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pyomyositis may mimic deep vein thrombosis and be misdiagnosed in patients with systemic lupus erythematosus (SLE). We report here on patient with SLE with severe thoracic pyomyositis presented with right upper arm swelling and fever. The patient fully recovered after a serial surgical debridement and antibiotic therapy. Pyomyositis, as well as deep vein thrombosis, should be considered during the differential diagnosis of patients with SLE experiencing fever and unilateral limb oedema. CT and identification of causal pathogens are crucial in the diagnosis of pyomyositis. Early effective antibiotic treatment as well as surgical intervention can together bring about a better outcome.
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Affiliation(s)
- Yu-Ning Kuo
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Sheng Lai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lai Kuo-Lung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Singh H, Kopp C, Sharma A, Sharma S, Naidu S, Jain S, Nada R, Dhir V. Primary Tuberculous Myositis-Report of a Case and Systematic Review of Literature in the Last 25 Years. J Clin Rheumatol 2022; 28:e278-e281. [PMID: 33323750 DOI: 10.1097/rhu.0000000000001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Chirag Kopp
- From the Department of Internal Medicine, Postgraduate Institute of Medical Education and Research
| | - Aman Sharma
- From the Department of Internal Medicine, Postgraduate Institute of Medical Education and Research
| | - Shefali Sharma
- From the Department of Internal Medicine, Postgraduate Institute of Medical Education and Research
| | - Shankar Naidu
- From the Department of Internal Medicine, Postgraduate Institute of Medical Education and Research
| | - Sanjay Jain
- From the Department of Internal Medicine, Postgraduate Institute of Medical Education and Research
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- From the Department of Internal Medicine, Postgraduate Institute of Medical Education and Research
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6
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Answer to October 2021 Photo Quiz. J Clin Microbiol 2021; 59:e0178219. [PMID: 34542327 DOI: 10.1128/jcm.01782-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Hempel AK, Gold WL, Luther RA. A Cold Case. Clin Infect Dis 2021; 72:1081-1083. [PMID: 33720321 DOI: 10.1093/cid/ciaa1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amanda K Hempel
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wayne L Gold
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, University Health Network, Toronto, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Canada
| | - Ryan A Luther
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Canada
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8
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Silva AMS, Almeida HC, Vianna MAA, Comello F, Zanoteli E. Skin Lesions and Multifocal Myositis in a Patient With Rheumatoid Arthritis. Clin Infect Dis 2020; 69:373-375. [PMID: 31263900 DOI: 10.1093/cid/ciy755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- André M S Silva
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo
| | | | | | | | - Edmar Zanoteli
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo.,Laboratório Fleury Medicina e Saúde, São Paulo, Brazil
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Thammaroj P, Panitchote A, Muktabhant C, Chowchuen P. Discrimination between tuberculous and bacterial pyomyositis in magnetic resonance features. Eur J Radiol Open 2020; 7:100214. [PMID: 33102635 PMCID: PMC7569411 DOI: 10.1016/j.ejro.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 01/31/2023] Open
Abstract
Discriminating imaging features between bacterial and tuberculous pyomyositis. T2 high signal intensity at abscess wall can predict for bacterial pyomyositis. Abscess wall character on imaging of bacterial muscle infection. Magnetic resonance imaging between bacterial and tuberculous muscle infection.
Purpose The purpose of this study was to assess the differences of magnetic resonance features between tuberculous and bacterial pyomyositis. Method This is a retrospective study of patients with bacterial and tuberculous pyomyositis. We excluded patients with pyomyositis caused by actinomycosis, non-tuberculous mycobacterium, fungi, unknown of causative organism, or inadequate imaging for analysis. Magnetic resonance imaging was independently reviewed by two radiologists. Results Of the 136 pyomyositis patients, 71 (52.2 %) patients had bacterial pyomyositis while 65 (47.8 %) patients had tuberculous pyomyositis. Seventy-seven patients (56.6 %) had intramuscular abscess. On multivariable analysis, bacterial pyomyositis was associated with diabetes mellitus (odds ratio [OR] 3.17, 95 % confidence interval [CI] 1.30–8.24) and bone marrow involvement (OR 5.02, 95 % CI 1.21–34.4). Spinal involvement had a significantly lower likelihood of bacterial pyomyositis (OR 0.25, 95 %CI 0.11–0.54). In patients with intramuscular abscess, diabetes mellitus and hyperintense on T2-weighted images at the abscess wall had a significantly higher likelihood of bacterial pyomyositis (OR 5.21, 95 %CI 1.33–25.42 and OR 5.34, 95 %CI 1.36–24.71, respectively), whereas spinal involvement had a significantly lower likelihood of bacterial pyomyositis (OR 0.09, 95 %CI 0.02–0.30). Conclusions Magnetic resonance imaging has modest accuracy for differentiation of tuberculous and bacterial pyomyositis. Diabetes mellitus and extraspinal pyomyositis were the predictors of bacterial pyomyositis. Presence of T2 hyperintense wall of intramuscular abscess was also the predictor of bacterial pyomyositis.
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Affiliation(s)
- Punthip Thammaroj
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Anupol Panitchote
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chawiporn Muktabhant
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Prathana Chowchuen
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Vattemi G, Guglielmi V, Marini M, Tomelleri G. Relapsing-remitting painful masses of the skeletal muscle. J Clin Pathol 2019; 73:439. [PMID: 31371398 DOI: 10.1136/jclinpath-2019-206090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/24/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Gaetano Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Valeria Guglielmi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Matteo Marini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Giuliano Tomelleri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
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Fountoukis T, Tsatsanidis N, Tilkeridou M, Konstantinou I, Fytas P, Skandalos I. Abdominal rectus muscle pyomyositis: Report of a case and review of the literature. Infect Dis Rep 2018; 10:7522. [PMID: 29721242 PMCID: PMC5907734 DOI: 10.4081/idr.2018.7522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 01/19/2023] Open
Abstract
Pyomyositis is an uncommon primary bacterial infection of skeletal muscles, usually caused by Staphylococcus aureus. Predisposing factors for pyomyositis include immunodeficiency, trauma, injection drug use, concurrent infection and malnutrition. The diagnosis, staging of the disease and differential diagnosis are established by ultrasound, CT and MRI. Treatment involves surgical drainage and antibiotic therapy. We report a case of abdominal rectus muscle pyomyositis, which constitutes, as far as we know, the second reported in bibliography, while Prevotella disiens is firstly reported as causative agent.
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Affiliation(s)
| | | | | | | | - Pantelis Fytas
- Microbiology Department, General Hospital Agios Pavlos, Thessaloniki, Greece
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Meesiri S. Pyomyositis in a patient with systemic lupus erythaematosus and a review of the literature. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-214809. [PMID: 27090546 DOI: 10.1136/bcr-2016-214809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pyomyositis (PM) is a common masquerading disease that is frequently misdiagnosed. A concurrent state of immunodeficiency is observed in up to 75% of tropical PM cases. PM in systemic lupus erythaematosus (SLE) is a relatively rare disease. I report a case of PM that was caused byKlebsiella pneumoniaein a patient with SLE who presented with leg pain, fever and a lupus flare-up. The patient was correctly diagnosed using a CT scan. Immediate surgical drainage was performed, and empirical antibiotics were administered. The patient was discharged while in a recovering condition. The clinical features, the results of radiographic investigations and the management of PM in SLE are synopsised in this article to underscore the importance of considering this relatively rare disease during differential diagnosis in patients with SLE with muscle pain with or without fever. I also emphasise the need to exclude mycobacterial infection in patients with SLE with PM.
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Affiliation(s)
- Somchai Meesiri
- Department of Surgery, Mae Sot General Hospital, Mae Sot, Tak, Thailand
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Tuberculous pyomyositis in an immunosuppressed patient. BIOMEDICA 2016; 36:23-8. [PMID: 27622621 DOI: 10.7705/biomedica.v36i3.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 07/28/2015] [Indexed: 11/21/2022]
Abstract
Tuberculous pyomyositis is a rare manifestation of extrapulmonary tuberculosis, most common in immunosuppressed patients, with clinical manifestations similar to pyomyositis of other etiologies, although with a lower age of presentation; notable risk factors include prior tuberculosis infection and pharmacological immunosuppression. Diagnosis depends on a high clinical suspicion of the infection in a susceptible population, given that microbiological isolation is often impossible. The response to treatment and prognosis are good. The case presented here is noteworthy given the rarity of this manifestation of tuberculosis and the slow response to first-line TB management in an HIV patient, despite susceptible microbiological isolation.
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