Methicillin-resistant Staphylococcus aureus Pyomyositis inducing Guillain-Barré Syndrome - A rare and unexpected clinical presentation

Tropical pyomyositis is characterized by deep suppurative skeletal muscle infection most commonly by Staphylococcal Aureus (S. aureus) with increasing incidence of infection by community acquired methicillin resistant S. aureus(CA-MRSA). The initial clinical presentation is generally non-specific and requires a high index of suspicion. We report the clinical course of a child from subtropical area of North India who developed multiple deep pyogenous collections, complicated with CA-MRSA septicaemia and followed by unusual complications consistent with Guillain-Barré Syndrome.

An unusual case of tropical pyomyositis: cryptococcal pyomyositis

The more common manifestations of cryptococcal infections are restricted to the central nervous system and lungs. A young man, suffering from idiopathic dilated cardiomyopathy with a left ventricular ejection fraction of 20%, presented with subacute, painful tender swelling in both legs initially attributed to congestive cardiac failure. No response to diuretics was achieved. Metabolically active lesions in the muscles of both lower limbs suggestive of muscle abscesses were found. A diagnosis of tropical pyomyositis was therefore made, but aspiration surprisingly revealed gram-positive yeast cells, staining of which on India ink and culture confirmed Cryptococcus. A good response to a combination of liposomal amphotericin B and flucytosine was obtained, but nevertheless the patient died from heart failure after induction of antifungal therapy.

Tropical Pyomyositis: diabetes facilitating the onset of an uncommon disease

Introduction: Tropical pyomyositis is an infectious disease that affects skeletal muscle and may appear as a diffuse inflammation or a rapidly progressive myonecrotic process. The predisposition of this disease in diabetics is already mentioned in several studies. The pathogenesis is possibly related to changes in neutrophils and the reversal of the immune response pattern that occurs in situations such as parasitic diseases. "Staphylococcus aureus" is the most common microorganism, accounting for 90% of cases of tropical pyomyositis. The diagnosis is sometimes late because patients usually do not seek care by the first symptoms, and because it is a rare disease and physicians are not very familiar with it. Case report: A 42-year-old male patient with diabetes mellitus, hypothyroidism, anemia, thrombocytopenia, and hypoalbuminemia developed tropical pyomyositis with multiple muscle abscesses in quadriceps, soleus and anterior tibial, triceps and biceps brachialis and pronator round, requiring prolonged antibiotic therapy and surgical drainage. Conclusion: Pyomyositis is a little known disease and if not diagnosed early can be fatal.