Disseminated Pyomyositis Due to Burkholderia cepacia: A Case Report

Abstract

Pyomyositis is a tropical infection affecting skeletal muscles manifesting as high-grade fever with pain in the affected limbs usually caused by Gram-positive microorganisms. Gram-negative organisms causing pyomyositis is uncommon but has been reported. Burkholderia cepacia is a Gram-negative nonfermenter causing opportunistic infections in immunocompromised patients, has been reported to cause pyomyositis only once before. We report a case of B. cepacia pyomyositis in a patient with no history of immunocompromised status, manifesting as disseminated infection with hemophagocytic syndrome presenting to our intensive care unit.

Keywords: Burkholderia cepacia; disseminated infection; pyomyositis.

Figure 1

(a) Ultrasonography of thigh revealing a small pocket of hypo-echoic collection within the inter-fascial plane. (b and c) Ultrasonography of upper arm revealing bulky muscle which is heterogeneous in echotexture with loss of fibrillar pattern with few hypoechoic areas – collection pockets. (d) Ultrasonography of thigh done few days after intensive care unit admission suggestive of better delineation of muscle fibrillary pattern and relatively normal muscle bulk. Small pocket of collection is still there

Figure 2

(a) Chest X-ray at admission to intensive care unit suggestive of bilateral diffuse alveolar infiltrates with well-preserved costo-phrenic angles and cardiac size. (b) Computed tomography chest at admission suggesting bilateral ground glass opacities with reticulation and small nodules distributed in both lung fields suggestive of acute respiratory distress syndrome

Figure 3

(a) Bone marrow smear showing increased histiocytes with prominent hemophagocytosis (Wright-Giemsa, ×400). (b) Motile Gram-negative straight bacilli after overnight incubation from the blood agar which are nonlactose fermenting catalase-positive and oxidase-positive