Pyomyositis. Report of 18 cases in Hawaii

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Abstract
Eighteen patients with pyomyositis were seen at a large hospital in Hawaii. Most were healthy young men or boys and 8 had never traveled abroad. Fever, muscle pain and swelling, and leukocytosis were common, but only 7 had erythema or fluctuance. A single large muscle was infected in 14, and 2 to 3 muscles were infected in the others. Pyomyositis mimicked cellulitis, muscle hematoma, thrombophlebitis, appendicitis and neoplasm. Staphylococcus aureus was found in 13, and Streptococcus pyogenes was found in 2. Bacteremia occurred in 29% (5/17). Drainage and antimicrobial agents were usually effective therapy, but 1 patient died and another had CNS damage. The pathogenesis is uncertain, but 12 had nonpenetrating muscle injury and 13 had pyoderma, suggesting that bacteria invade injured muscle via the bloodstream or lymphatic system.

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