Severe thoracic pyomyositis in a patient with systemic lupus erythematosus

Abstract

Pyomyositis may mimic deep vein thrombosis and be misdiagnosed in patients with systemic lupus erythematosus (SLE). We report here on patient with SLE with severe thoracic pyomyositis presented with right upper arm swelling and fever. The patient fully recovered after a serial surgical debridement and antibiotic therapy. Pyomyositis, as well as deep vein thrombosis, should be considered during the differential diagnosis of patients with SLE experiencing fever and unilateral limb oedema. CT and identification of causal pathogens are crucial in the diagnosis of pyomyositis. Early effective antibiotic treatment as well as surgical intervention can together bring about a better outcome.

Keywords: connective tissue disease; plastic and reconstructive surgery; tropical medicine (infectious disease).

Figure 1

Axial views (A and B) and sagittal view (C) obtained from multidetector CT on hospital day 8. They demonstrate (A) large area of an abscess formation over inner part of the right upper chest wall, particularly the pectoralis muscles, which also compressed to the right lateral part of superior vena cava (star); (B) abscess compressed to distal end of the right subclavian vein (star); (C) abscess extended to right lower neck and mediastinum (star).

Figure 2

(A) Intraoperative photography showed a partially necrotic pectoralis major muscle and presence of extensive necrotic tissues between the pectoralis minor and major muscles. (B) The surgical wound was sutured on hospital day 22, with a tubing put in place for continuous drainage.