PYOMYOSITIS: AN UNSUAL MODE OF PRESENTATION IN INFECTIVE ENDOCARDITIS

Few cases of pyomyositis associated with native valve IE have been described. S. aureus was isolated in the majority, with predilection for large muscle groups. Diabetes and immunosuppression are predisposing factors and most times there are no risk procedures identifiable. Of note, our patient fulfilled all these characteristics. However, given the rarity of this complication, it was not initially suspected.

Although surgical drainage was considered, it was not performed because the abscesses were disseminated all over the body. This case highlights that this uncommon complication can be successfully treated with percutaneous drainage and antibiotic treatment.

Interestingly, the presence of normal central venous pressure in our patient ruled out right heart failure as the cause of limb oedemas and raised the suspicion of a peripheral cause, which was confirmed with a magnetic resonance imaging study. It is the diagnostic modality of choice, although definitive diagnosis requires culture of the abscess purulent material.

A relationship between MSSA toxin producing strains and muscle tropism has been suggested. This underscores the importance of identifying not only the etiological agent but also whether that specifical Staphylococcal clone produces the toxic shock syndrome toxin-1 to anticipate possible associated complications. In this case, the use of antibiotics protein-synthesis inhibitors would be recommended.

Funding:

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Conflicts of interest:

We all declare no conflicts of interest.