Subcutaneous nodules caused by Pseudomonas aeruginosa: healing without incision and drainage

Pseudomonas aeruginosa Pyomyositis in a Child With Acute Lymphoblastic Leukemia: A Case Report and Review of Literature

BACKGROUND

We report the case of an 11-year-old girl with a recent diagnosis of common B-cell acute lymphoblastic leukemia who presented with Pseudomonas aeruginosa pyomyositis of the left lower limb during severe neutropenia associated with the induction phase of chemotherapy.

OBSERVATIONS

Presenting signs included fever, leg pain, and refusal to walk. Popliteal knee ultrasonography was unremarkable, whereas magnetic resonance imaging showed 2 intramuscular fluid collections requiring surgically drainage.

CONCLUSION

A review of medical literature showed that pyomyositis is an infrequent complication in children with hematological malignancies, and most cases are due to Staphylococcus aureus, whereas Pseudomonas aeruginosa appears to be rarely involved.

A Serious Complication of Allogeneic Stem Cell Transplantation: Relapsing Pseudomonas aeruginosa Panniculitis

A 58-year-old female following an allogeneic stem cell transplant (alloSCT) presented with tender subcutaneous nodule in the axillary and inguinal regions. One of the nodules was biopsied and cultured. The patient was diagnosed with Pseudomonas aeruginosa ( P. aeruginosa) panniculitis. Blood cultures were negative for P. aeruginosa. The patient responded to 4 weeks of imipenem-cilastatin and gentamicin treatment but relapsed immediately after the discontinuation of antibiotic treatment with a change in the susceptibility of P. aeruginosa to antibiotics. The patient received piperacillin-tazobactam and aztreonam with no recurrence for nine months. Differential diagnosis of subcutaneous nodules can be difficult in an alloSCT setting. P. aeruginosa should be kept in mind, and the biopsy and culture of a nodule should be obtained without delay. Blood cultures can be negative. Despite long term antibiotic treatment, relapse can occur.

Pyomyositis associated with hematological malignancy: case report and review of the literature

Pyomyositis occurs most commonly in patients with various immunosuppressive diseases. However, the association of pyomyositis with an underlying hematological malignancy has not been reviewed. We present herein a relevant case and also review the available literature regarding the association of non-tropical pyomyositis and hematological malignancies. The case patient, a 46-year old female, had non-tropical pyomyositis of the iliopsoas and obturator muscles due to Staphylococcus aureus and underlying Hodgkin's disease. Forty-four patients with pyomyositis and an associated hematological malignant disease have been reported in the literature. The most common types of hematological oncology diseases found were acute lymphocytic leukemia (present in 11/44 patients (25%)) and multiple myeloma (7/44 patients (15.9%)). Staphylococcus aureus was the most common cause of pyomyositis (26 out of 44 patients (59.1%)). The muscles of the thigh were most commonly affected (18/44 patients (40.9%)). Medical therapy with antibiotics and surgical drainage were employed in 25/44 (56.8%) of the patients. Thirty out of 44 (68.2%) of the patients had a successful outcome. Death occurred in 5/44 (11.4%) patients. In cases of pyomyositis, the physician should consider an underlying hematological malignancy.