Tropical Pyomyositis: Revisited

Abstract

Since the initial description of tropical pyomyositis 130 years ago, this disease continues to retain some mystery for physicians and surgeons. The infrequency, variable epidemiologic and demographic profile, diagnostic dilemmas and limited literature continue to make it an enigma with limited understanding. In the span of nearly 130 years, worldwide English literature search has revealed an average of only two to three reported cases every year globally. We recently managed a case of tropical pyomyositis which posed a clinical and radiologic diagnostic dilemma. The rarity of disease and published literature prompted us to garner demographic and disease characteristics data from historical review of two Pan-Indian journals, with the aim of aiding management. Data has been screened since 1950 from the Medical Journal Armed Forces India (MJAFI) and the Indian Journal of Surgery (IJS), which report cases from different geographical conditions and ethnicity all over the nation. We found only six case reports in the MJAFI, while there was surprisingly no publication regarding pyomyositis in the IJS. We present a case report of a 39-year-old male who developed pyomyositis of the left calf muscle and review published data from these journals over the last 65 years.

Keywords: Calf muscle; Indian Journal of Surgery; Medical Journal Armed Forces India; Pyomyositis.

Fig. 1

a, b Axial T2W and STIR images showing an increase in the bulk and hyperintense signal in the muscles (arrow) of the anterior and posterior compartment of the left leg

Fig. 2

a, b Post-contrast axial and coronal images showing heterogeneous enhancement of the affected muscles and multiple focal collections with peripheral enhancement in the muscles of the deep posterior compartment (arrow)