Sternocleidomastoid pyomyositis

Isolated left sternocleidomastoid pyomyositis: a rare presentation of cervical sepsis

An elderly gentleman self-presented to A+E with a 7-day history of significant and progressive left-sided neck pain, swelling and fevers, despite oral antibiotics from his general practitioner. Examination revealed a large left-sided neck mass involving levels 2-5 of the neck that was firm to palpate, with erythematous overlying skin.An urgent CT scan demonstrated a large collection throughout the length of the left sternocleidomastoid muscle (SCM), measuring 13×5.5×4 cm, with extensive adjacent inflammatory change. He was subsequently taken to theatre for washout and debridement, during which the collection was found to be loculated and isolated to the SCM, with surrounding structures spared.Postoperatively, he was managed with intravenous fluids and a total of 2 weeks of intravenous antibiotics. The wound partially dehisced during healing and the cavity was packed with flaminal and regularly dressed with input from the tissue viability team. This was then left to heal by secondary intention and the patient was followed up in clinic over the following weeks to ensure resolution.

Bacterial Pyomyositis in the Neck Due to Bacteroides Fragilis

Bacterial pyomyositis is characterized by the formation of abscesses in skeletal muscle groups, frequently in the lower extremities. It is most prevalent in tropical climates and associated with Staphylococcus aureus. The presentation of pyomyositis in the neck is rare. We present a unique case of pyomyositis caused by a gut bacterium, Bacteroides fragilis. Additionally, the case highlights the difficulty in identifying the cause of spread of the bacteria from the gut to the affected musculature.

A 77-year-old diabetic Caucasian male presented with progressive bilateral neck swelling and limited range of motion of the neck. CT imaging confirmed a peripherally enhancing sternocleidomastoid abscess, right pectoralis major muscle abscess, and a hypodense fluid collection found in the anterior mediastinum and retrosternal space. The patient underwent exploration with incision and drainage of the abscess. Blood and tissue culture-confirmed Bacteroides fragilis. Subsequent abdominal CT imaging revealed a perforated ascending colon, which, is thought to be responsible for the source of the bacterium.

Bacterial pyomyositis is a rare condition and if not treated early can lead to sepsis and death. We present a rare case of bacteria from a gastrointestinal (GI) source that has not been reported in the literature. This highlights the importance of a thorough evaluation of a source of infection in patients with pyomyositis, especially in the setting of atypical microbes.

Fever and Hip Pain: Not Always Due to a Septic Hip

Hip pain in febrile children always raises concern for septic arthritis. Pyomyositis is a rare cause of hip pain. Because it involves muscles around the joint, it may have a similar presentation as a septic hip. This entity therefore has the potential for posing a diagnostic dilemma when physicians face a limping child with fever. We report a child who presented with fever and hip pain and has pyomyositis of the obturator internus muscle. This case underscores the need to consider the possibility of alternative etiologies in a limping child.

Sonographic appearance of pyomyositis of the sternocleidomastoid muscle: A case report

Pyomyositis in the neck has rarely been described. We present the sonographic findings in a case of pyomyositis of the sternocleidomastoid muscle. A 62-year-old man with poorly controlled diabetes presented with an induration of the neck and fever. On gray-scale sonography, a part of the sternocleidomastoid muscle appeared swollen and contained irregularly shaped hypoechoic areas. Power Doppler imaging showed increased vascularity in the muscle. Sonographic-guided aspiration confirmed abscesses in the sternocleidomastoid muscle. Surgical drainage was successfully performed along with antibiotic treatment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:520-523, 2017.

Thigh pyomyositis caused by group A streptococcus in an immunocompetent adult without any cause

Background

Pyomyositis is typically caused by Staphylococcus aureus, and is rare in temperate climates, although its prevalence has been recently increasing. This infection often involves the thigh, and is associated with immunodeficiency.

Case presentation

We report the case of a healthy 20-year-old Japanese woman who experienced a fever and continuous pain for several days. She was admitted to our hospital and was diagnosed with pyomyositis after we discovered an abscess between the muscles of her dorsal distal left thigh using computed tomography. This is a rare case of thigh pyomyositis, as it was caused by group A streptococcus and occurred in an immunocompetent adult from a temperate climate.

Conclusions

Our review of the literature revealed that group A streptococcus pyomyositis typically occurs in temperate climates, among young adults without any underlying disease, and is associated with a poorer prognosis, compared to general pyomyositis. We suggest that pyomyositis should be considered when immunocompetent adults present with apparently idiopathic inflammatory muscle lesions.