- Department of Pediatrics, Hospital of Saint Omer, 62500, France
- Department of Radiology, Lille University Hospital, 59037, France
Department of Radiology, Lille University Hospital, 59037, France
DOI:10.4103/2152-7806.130718Copyright: © 2014 Boulyana M This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Boulyana M, Kilani MS. Nontropical pyomyositis complicated with spinal epidural abscess in a previously healthy child. Surg Neurol Int 16-Apr-2014;5:
How to cite this URL: Boulyana M, Kilani MS. Nontropical pyomyositis complicated with spinal epidural abscess in a previously healthy child. Surg Neurol Int 16-Apr-2014;5:. Available from: http://sni.wpengine.com/surgicalint_articles/nontropical-pyomyositis-complicated-with-spinal-epidural-abscess-in-a-previously-healthy-child/
Background:Pyomyositis (PM), a rare pyogenic infection that involves skeletal muscles, if not immediately diagnosed, can be fatal. Most notably, this results in spinal epidural abscess (SEA) in typically unhealthy individuals.
Case description:We present a very rare nontropical PM complicated with SEA in a previously healthy child revealed by Magnetic resonance imaging (MRI). Our patient recovered without complications 5 years after abscess drainage and antibiotics.
Conclusion:PM remains a challenge to clinicians and should be considered in the differential diagnosis of musculoskeletal pain. MRI is the investigation of choice of spinal infection and should be undertaken at an early stage.
Keywords: Pyomyositis, Spinal epidural abscess, MRI, children
First described by Scriba[
We report a very rare case of PM and SEA in a 13-year-old previously healthy boy. He was admitted because of a progressive pain located in the left gluteal region and then left L5 sciatica. On admission, physical examination was normal with stable vital signs. He was febrile at 39°C and neurologic examination revealed a reduced Lasegue sign on the left. Laboratory tests showed an elevated C-reactive protein (CRP) at 92 mg/l without leukocytosis. Blood culture was positive for a methicillin-sensitive Staphylococcus aureus (MSSA). Initially, the spinal plain radiographs, ultrasound, computerized tomography scan, and bone scintigraphy showed no abnormality. Subsequently, spinal magnetic resonance imaging (MRI) with Gadolinium injection revealed left paraspinal muscular enhancement and multiple intramuscular fluid collections with thick enhancing wall [Figures
PM is a primary infection of skeletal muscles, which is endemic in the tropics where it represent 4% of surgical admissions.[
Once diagnosed, treatment of PM consists of appropriate antibiotics and possible abscess drainage depending on its size and pressure symptoms.[
Although rare, PM should be considered in the differential diagnosis of musculoskeletal pain. A delay in diagnosis can be fatal. Early diagnosis and appropriate antibiotic following drainage are important as major complications can be avoided. Having a high sensitivity, MRI is the investigation of choice of spinal infection.
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