Fulminant Necrotizing Pyomyositis Tropicans

Abstract

Pyomyositis tropicans is a purulent invasive infection of the striated muscle tissues, usually caused by Gram-positive bacteria Staphylococcus aureus and Streptococcus in immunocompromised patients. We hereby report a case of fulminant necrotizing pyomyositis that occurred in a 16-year-old immunocompetent patient, and it is the first one of its kind to the best of our knowledge. The patient underwent imaging which suggested extensive intramuscular abdominal wall abscess formation, for which the patient underwent multiple surgical debridements of the lateral thoracic wall. Subsequent cultures grew Escherichia coli as the causative organism. Postoperatively, the patient went into catastrophic, irreversible septic shock ending in an eventual fatality.

Keywords: antibiotics; debridement; immunocompetent; pyomyositis; septic shock.

Figure 1. Plating of the organism from the blood culture showing colonies of the Escherichia coli.

Figure 2. A) Gram staining of the exudates from the pus having Gram-negative rods and B) the necrotic muscle having Gram-negative rods and pus cells.

Figure 3. Chest x-ray showing no evidence of any infectious origin or pleural effusion.

Figure 4. CT (axial view) abdomen showing evidence of intramuscular and submuscular pus (arrow) with fat stranding around the muscle in the left flank region.

Figure 5. Postoperative wound over the left flank and back region after debridement.