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Category: Volume 07 Issue 10 October 2019
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Title: A Rare Presentation of Adult tropical Pyomyositis with Paget Schroetter Syndrome

Authors: Dr Ashiti Jain, Dr Vandana Dandekar, Dr Jaishree Ghanekar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.92

Abstract

  

Reporting a case of 25 year male, labourer, who presented in ER with complaints of acute onset shortness of breath with orthopnoea, right sided chest pain. On admission patient had tachycardia, hypotension with erythema and tenderness present over right side of chest. The events followed after pulling a 60 kg load manually. B/l lower limb doppler was s/o DVT. Right upper limb Doppler was suggestive of thrombus in right IJV and Subclavian vein. Mri right shoulder revealed multiple abscess in muscles of right shoulder and back. The abscess was drained by the surgical team and culture and sensitivity grew staphylococcus aureus thereby confirming the diagnosis of tropical pyomyositis with pagetschroetter syndrome.

Tropical pyomyositis is a disease of tropical countries, which is characterised by suppuration within skeletal muscles, presenting as single or multiple abscesses. The diagnosis is confirmed either by aspiration of pus from the affected muscles or biopsy. Upper extremity deep vein thrombosis (UEDVT) is seen in approximately 5 to 10 percent of all cases of DVT, classically occurring in the dominant arm of young athletes. The purpose of the case report is to make physicians more familiar with this potentially life threatening but curable infective disease entity.

References

  1. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgraduate Medical Journal [Internet]. 2004 May 1 [cited 2018 Dec 8];80(943):267–70. Available from: https://pmj.bmj.com/content/80/943/267
  2. Meena M, Harish S, Kewlani JP, Gupta N, Meena VK. Paget-Schroetter Syndrome. Chin Med J (Engl) [Internet]. 2015 Oct 5 [cited 2018 Dec 7];128(19):2694–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736857/
  3. Chiedozi LC. Pyomyositis. Review of 205 cases in 112 patients. Am J Surg. 1979 Feb;137(2):255–9.
  4. Chauhan S. Tropical pyomyositis (myositis tropicans): current perspective. Postgraduate Medical Journal [Internet]. 2004 May 1 [cited 2018 Nov 21];80(943):267–70. Available from: http://pmj.bmj.com/cgi/doi/10.1136/pgmj.2003.009274
  5. Traquair RN. Pyomyositis. J Trop Med Hyg. 1947 May;50(5):81–9.
  6. Bonafede P, Butler J, Kimbrough R, Loveless M. Temperate zone pyomyositis. West J Med. 1992 Apr;156(4):419–23.
  7. Diamandakis V, Grose C. Bad consequences of bicycle accidents: Pyomyositis. Pediatric infectious disease journal. 1994;13(5):422–425.
  8. Jayoussi R, Bialik V, Eyal A, Shehadeh N, Etzioni A. Pyomyositis caused by vigorous exercise in a boy. Acta Paediatr. 1995 Feb;84(2):226–7.
  9. Temperate pyomyositis in an injecting drug misuser. A difficult diagnosis in a difficult patient | Emergency Medicine Journal [Internet]. [cited 2018 Dec 17]. Available from: https://emj.bmj.com/content/20/3/299?ijkey=65a05ac96051bc494b88e20b419f3a27717bfd72&keytype2=tf_ipsecsha
  10. Christin L, Sarosi GA. Pyomyositis in North America: case reports and review. Clinical infectious diseases. 1992;15(4):668–677.
  11. Sarubbi FA, Gafford GD, Bishop DR. Gram-negative bacterial pyomyositis: unique case and review. Reviews of infectious diseases. 1989;11(5):789–792.
  12. Minami K, Sakiyama M, Suzuki H, Yoshikawa N. Pyomyositis of the vastus medialis muscle associated with Salmonella enteritidis in a child. Pediatric radiology. 2003;33(7):492–494.
  13. Wolf RF, Konings JG, Prins TR, Weits J. Fusobacterium pyomyositis of the shoulder after tonsillitis: Report of a case of Lemierre’s syndrome. Acta orthopaedica Scandinavica. 1991;62(6):595–596.
  14. Tuberculous pyomyositis in an immunosuppressed patient [Internet]. [cited 2018 Dec 17]. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-41572016000500004
  15. Fincher R-ME, Jackson MW, Fischer AQ. Case report: Citrobacter freundii: a newly reported cause of pyomyositis. The American journal of the medical sciences. 1990;299(5):331–333.
  16. Brook I. Pyomyositis in children, caused by anaerobic bacteria. Journal of pediatric surgery. 1996;31(3):394–396.
  17. Smith IM, Vickers AB. Natural History of 338 Treated and Untreated Patients with Staphylococcal septicaemia (1936-1955.). Lancet. 1960;1318–22.
  18. Miyake H. Beitrage zur Kenntnis der sogenannten Myositis infectiosa. Mitt Grenzgeb Med Chir. 1904;13:155–198.
  19. Hall RL, Callaghan JJ, Moloney E, Martinez S, Harrelson JM. Pyomyositis in a temperate climate. Presentation, diagnosis, and treatment. J Bone Joint Surg Am [Internet]. 1990 Sep [cited 2018 Dec 17];72(8):1240–4. Available from: http://europepmc.org/abstract/med/2398094
  20. Idoko JA, Oyeyinka GO, Giassudin ASM, Naida A. Neutrophil cell function and migration inhibition studies in Nigerian patients with tropical pyomyositis. Journal of Infection. 1987;15(1):33–37.
  21. Rodgers WB, Yodlowski ML, Mintzer CM. Pyomyositis in patients who have the human immunodeficiency virus. Case report and review of the literature. JBJS. 1993;75(4):588–592.
  22. Musculoskeletal manifestations in patients positive for human immunodeficiency virus: correlation with CD4 count. | The Journal of Rheumatology [Internet]. [cited 2018 Dec 17]. Available from: http://www.jrheum.org/content/28/4/802?ijkey=40c40eed527ab0f9c4fc7a20be8817cb2ae1fda2&keytype2=tf_ipsecsha
  23. Ashken MH, Cotton RE. Tropical skeletal muscle abscesses (pyomyositis tropicans). British Journal of Surgery. 1963;50(226):846–852.
  24. Chukawama CL. Pyomyositis. Am J Surg. 1979;137:255–9.
  25. Gambhir IS, Singh DS, Gupta SS, Gupta PR, Kumar M. Tropical pyomyositis in India: a clinico-histopathological study. The Journal of tropical medicine and hygiene. 1992;95(1):42–46.
  26. Andy JJ, Ekpo EB. Cardiovascular complications of tropical pyomyositis. Tropical and geographical medicine. 1987;39(3):260–264.
  27. Shepherd JJ. Tropical myositis: is it an entity and what is its cause? The Lancet. 1983;322(8361):1240–1242.
  28. Brown JD, Wheeler B. Pyomyositis: report of 18 cases in Hawaii. Archives of internal medicine. 1984;144(9):1749–1751.
  29. Mathew UE, Ray A, Soneja M, Vyas S, Sanker K, Nischal N, et al. Pyomyositis Complicated by Deep Venous Thrombosis-A Unique Case of Reverse Lemierre’s Syndrome. Journal of The Association of Physicians of India. 2017;65:87.
  30. Soler R, Rodrı́guez E, Aguilera C, Fernández R. Magnetic resonance imaging of pyomyositis in 43 cases. European journal of radiology. 2000;35(1):59–64.
  31. Immerman RP, Greenman RL. Toxic shock syndrome associated with pyomyositis caused by a strain of Staphylococcus aureus that does not produce toxic-shock-syndrome toxin-1. The Journal of infectious diseases. 1987;156(3):505–507.
  32. Flory P, Brocq O, Euller-Ziegler L, Ziegler G. Pyomyositis: cervical localization. The Journal of rheumatology. 1993;20(8):1411–1413.
  33. Upper Extremity Deep Vein Thrombosis [Internet]. American College of Cardiology. [cited 2019 Jan 10]. Available from: http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2017%2f11%2f09%2f13%2f30%2fupper-extremity-deep-vein-thrombosis
  34. Upper Extremity Deep Vein Thrombosis [Internet]. American College of Cardiology. [cited 2019 Jan 10]. Available from: http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2017%2f11%2f09%2f13%2f30%2fupper-extremity-deep-vein-thrombosis
  35. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgraduate medical journal. 2004;80(943):267–270.

Corresponding Author

Dr Ashiti Jain

Junior Resident, Internal Medicine, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India