Physician Nebraska Methodist Hospital / Methodist Physicians Clinic Omaha, Nebraska, United States
Case Diagnosis: Pyomyositis is a purulent infection of skeletal muscle commonly caused by Staphlococcus Auerus with muscle suppuration, abscesses, and hematogenous spread. It’s divided into tropical and temperate forms affecting different demographics. While the tropical form affects healthy individuals, the temperate variety patients are typically immunocompromised. Risk factors include skeletal muscle trauma, IV drug use, malnutrition, and immunodeficiency. Pyomyositis presents with fever, pain, and single muscle group cramping, most commonly in the lower extremity.
Case Description: We present a 55-year-old male with a past medical history of malignant melanoma of the right scapula with recent diagnosis of small lymphocytic lymphoma (Lugano stage IV M+, high CD38, Del 11q, Del 17p) admitted with a several day history of weakness, dizziness, and bilateral lower extremity pain, left greater than right. He was diagnosed with severe anemia, and septic shock with blood cultures positive for Streptococcus dysgalactiae. MRI of his left thigh with/without contrast was obtained revealing “diffuse edema in the left vastus lateralis and anterior portion of the adductor magnus with peripherally enhancing fluid collections predominately in vastus lateralis. Imaging characteristics are concerning for pyomyositis.” Broad spectrum IV antibiotics were initiated. The cause of his lower extremity swelling and pain was presumed secondary to bacterial seeding from sepsis. He continued to improve medically over the next few days.
Discussions: Due to his significant deconditioning, weakness, and pain impacting his function, he was admitted to the acute inpatient rehabilitation unit. The therapy course was uncomplicated for this patient, and only PT and OT were indicated. There was no restrictions other than limitations secondary to pain.
Conclusions: The rehabilitation course of this complicated patient is important for the future care of other patients with complicated pyomyositis. More evidence and data is needed when initiating a rehabilitation plan in a patient with septic shock related pyomyositis.