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Review
. 2023 Jun 14;49(1):73.
doi: 10.1186/s13052-023-01472-1.

Pyomyositis associated with abscess formation caused by streptococcus pneumoniae in children: a case report and review of literature

Luca Barchi  1 , Michele Fastiggi  2 , Ilaria Bassoli  3 , Federico Bonvicini  2 , Monica Silvotti  4 , Lorenzo Iughetti  3 , Alessandro De Fanti  2
Affiliations
Review

Pyomyositis associated with abscess formation caused by streptococcus pneumoniae in children: a case report and review of literature

Luca Barchi et al. Ital J Pediatr. .

Abstract

Background: Pyomyositis is an unusual bacterial infection but potential severe in children. Staphylococcus Aureus is the main caused of this disease (70-90%), following by Streptococcus Pyogenes (4-16%). Streptococcus Pneumoniae rarely caused invasive muscular infections. We describe a case of pyomyositis caused by Streptococcus Pneumonia in an adolescent 12-year-old female.

Case presentation: I.L. referred to our hospital for high fever associated with right hip and abdominal pain. The blood exams showed increase of leukocytes with prevalence of neutrophils with high level of inflammatory markers (CRP 46,17 mg/dl; Procalcitonin 25,8 ng/ml). The abdomen ultrasonography was unremarkable. The CT and MRI of the abdomen and right hip revealed pyomyositis of the iliopsoas, piriformis and internal shutter associated with collection of pus between the muscular planes (Fig. 1). The patient was admitted to our paediatric care unit, and she was initially treatment with intravenous Ceftriaxone (100 mg/kg/day) and Vancomycin (60 mg/kg/day). On day 2, a pansensitive Streptococcus Pneumoniae was isolated from the blood culture, and the antibiotic treatment was changed to only IV Ceftriaxone. She was successively treated with IV Ceftriaxone for 3 weeks, then continued with oral Amoxicillin for a total of 6 weeks of therapy. The follow up showed a complete resolution of the pyomyositis and psoas abscess after 2 months.

Conclusion: Pyomyositis associate with abscess is a rare and very dangerous disease in children. The clinical presentation can mimic symptoms of other pathologies like osteomyelitis or septic arthritis, so many times is hard to identify. The main risk factors include story of recent trauma and immunodeficiency, not present in our case report. The therapy involves the antibiotics and, if possible, abscess drainage. In literature there is much discussion about duration of antibiotic therapy.

Keywords: Children; Myositis; Psoas abscess; Pyomyositis; Streptococcus Pneumoniae.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Short Time Inversion Recovery (STIR) MRI. The imagine shows edema of iliopsoas, piriformis and internal shutter. Between muscles there are multiple bunches (6 × 3,5 cm)
Fig. 2
Fig. 2
Magnetic Resonance Imaging after two months. we observed a completely resolution of muscles edema and abscess formation
See this image and copyright information in PMC

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