Presentación atípica de piomiositis tropical difusa de psoas por Staphylococcus aureus meticilino resistente

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Abstract

La piomiositis tropical difusa primaria es una enfermedad de presentación infrecuente en nuestro medio, con pocos casos asociados a Staphylococcus aureus meticilino resistente, adquirido en la comunidad (MRSA-AC). Se presenta el caso de un paciente de 70 años, con tratamiento irregular para diabetes mellitus tipo 2, que fue hospitalizado por presentar un cuadro de diez días de evolución, con dolor lumbar irradiado a miembro inferior izquierdo, fiebre y flexión forzada de la cadera derecha por dolor a la movilización. El diagnóstico de piomiositis difusa de ambos psoas se realizó con resonancia magnética. Del cultivo de una colección paravertebral posterior se aisló Staphylococcus aureus resistente a oxacilina, penicilina y dicloxacilina.

Translated abstract

Diffuse tropical primary pyomyositis is an infrequent entity in our country, with few cases associated to communityacquired Methicillin- resistant Staphylococcus aureus. There are no reported cases of Community-Acquired Methicillin- Resistant Staphylococcus aureus (CA- MRSA) in Peru. We present the case of a 70 year old male with a previous diagnosis of type 2 diabetes mellitus, receiving irregular treatment, who was admitted to the hospital with a history of 10 days of low back pain radiating to the left leg, fever and forced flexion of the right hip due to pain during movement. The diagnosis of diffuse pyomyositis of both psoas muscles was performed with MRI and culture of a posterior paravertebral collection, from which Staphylococcus aureus resistant to oxacillin, penicillin and dicloxacillin was isolated.

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Most cited references 10

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Tropical pyomyositis (myositis tropicans): current perspective.

S. Chauhan, S. Jain, Nadimpalli Varma (2004)

Tropical pyomyositis, a disease often seen in tropical countries, is characterised by suppuration within skeletal muscles, manifesting as single or multiple abscesses. The most common organism implicated is Staphylococcus aureus. In 20%-50% of cases there is a history of trauma to the affected muscles. Commonly involved muscles are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Early diagnosis is often missed because of lack of specific signs, unfamiliarity with the disease, atypical manifestations, and a wide range of differential diagnosis. Diagnostic techniques like ultrasound and computed tomography/magnetic resonance imaging are very useful in diagnosis. The diagnosis is confirmed either by biopsy or aspiration of pus from the affected muscles. The initial antibiotic of choice is cloxacillin. Incision and drainage are important components of management. Treatment for Gram negative or anaerobic organisms should be instituted, whenever indicated. Physicians should become more familiar with this potentially life threatening but curable infective disease entity.

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Pyomyositis: clinical features and predisposing conditions.

James L Perruquet, Eric Harrington, Upen S Patel … (1997)

To describe the manifestations of nontropical pyomyositis and associated comorbid conditions that may predispose to pyomyositis. A retrospective review of 13 patients with pyomyositis seen at our center including one illustrative case report. Reports of tropical and nontropical pyomyositis were found by review of Index Medicus, Medline, and references from published cases and clinical review papers. All 13 patients had variable presentations including fever, muscle pain, tenderness, and swelling. Eleven patients had comorbid conditions that may have led to their infection, including one with human immunodeficiency virus and 3 with history of trauma. Staphylococcus aureus was found to be a causative organism in 7 patients, 2 patients had multiple organisms isolated, and 2 had no organisms isolated. Eleven patients had successful treatment with intravenous antibiotics and either computerized tomographic scan guided percutaneous or open operative drainage. Onset of pyomyositis is usually insidious, with progression to purulent collections. Comorbid conditions likely predispose patients to pyomyositis and may contribute to delay in diagnosis and treatment. Increased awareness of this disease, especially in an immunosuppressed patient, should lead to earlier diagnosis and treatment with improved outcomes.