Cervical pyomyositis: Commoner than what we thought

Norhafizah Saifudin, Mohd. Razif Mohamad Yunus, Carren Teh Sui Lin, Intan Kartika Kamarudin

Research output: Contribution to journalArticle

Abstract

Introduction: Pyomyositis or tropical myositis is a bacterial infection of the skeletal muscle, manifesting as a local abscess but also as a diffuse inflammatory or rapidly progressive myonecrotic process. Muscles commonly involved are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Cervical pyomyositis is reported as rare with only six separate cases reported in the world since 1992 with the most recent in February 2016. However, within a year, we have succeeded in collecting the first case series of cervical pyomyositis in Sungai Buloh Hospital. Objective: To study 5 cases of cervical pyomyositis presented in Sungai Buloh Hospital and to discuss the appropriate management Design: Case series. Case presentation: We report 5 cases of cervical pyomyositis presented in Sungai Buloh Hospital in 2015.Three out of five cases were immunocompetent patients and most of them come from low socioeconomic background. They presented with unilateral neck swelling, pain and fever. Computed tomography of the neck showed intramuscular sternocleidomastoid muscle abscess and there was only one patient has involvement of masseter muscle. In this case series, there were multiorganism isolated such as Staphylococcus Aureus, Klebsiella species, Streptococcus Pyogenes. Four underwent incision and drainage and one patient had ultrasound guided drainage. Concurrently, they were all treated with intravenous cefuroxime and metronidazole. Duration of stay was four to thirteen days. All of them well postoperatively and continued to do well when reviewed later in the clinic. Discussion: Cervical pyomyositis has been reported as a rare condition thus far however our case series proves otherwise. The common denomination which all patients shared was their socioeconomically background. Computed tomography scan was crucial in obtaining a diagnosis and to delineate the extension of intramuscular abscess which was important for surgical intervention. Delayed diagnosis has been reported to cause internal jugular vein thrombosis, sepsis and death. Fortunately, our case series show that treatment with intravenous antibiotics and drainage of the abscess was adequate without any untoward complications. Conclusion: We should consider cervical pyomyositis in any painful swelling in head and neck region as it is no longer as rare as reported especially when patients are from a lower socioeconomical background.

Original languageEnglish
Pages (from-to)391-393
Number of pages3
JournalInternational Medical Journal
Volume24
Issue number5
Publication statusPublished - 1 Oct 2017

Fingerprint

Pyomyositis
Abscess
Drainage
Neck
Tomography
Masseter Muscle
Abdominal Muscles
Cefuroxime
Muscles
Klebsiella
Neck Pain
Streptococcus pyogenes
Delayed Diagnosis
Jugular Veins
Metronidazole
Case Management
Bacterial Infections
Staphylococcus aureus
Sepsis
Skeletal Muscle

Keywords

  • Abscess
  • Myositis
  • Pyomyositis
  • Sepsis
  • Staphylococcal infections

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Saifudin, N., Mohamad Yunus, M. R., Lin, C. T. S., & Kamarudin, I. K. (2017). Cervical pyomyositis: Commoner than what we thought. International Medical Journal, 24(5), 391-393.

Cervical pyomyositis : Commoner than what we thought. / Saifudin, Norhafizah; Mohamad Yunus, Mohd. Razif; Lin, Carren Teh Sui; Kamarudin, Intan Kartika.

In: International Medical Journal, Vol. 24, No. 5, 01.10.2017, p. 391-393.

Research output: Contribution to journalArticle

Saifudin, N, Mohamad Yunus, MR, Lin, CTS & Kamarudin, IK 2017, 'Cervical pyomyositis: Commoner than what we thought', International Medical Journal, vol. 24, no. 5, pp. 391-393.
Saifudin, Norhafizah ; Mohamad Yunus, Mohd. Razif ; Lin, Carren Teh Sui ; Kamarudin, Intan Kartika. / Cervical pyomyositis : Commoner than what we thought. In: International Medical Journal. 2017 ; Vol. 24, No. 5. pp. 391-393.
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N2 - Introduction: Pyomyositis or tropical myositis is a bacterial infection of the skeletal muscle, manifesting as a local abscess but also as a diffuse inflammatory or rapidly progressive myonecrotic process. Muscles commonly involved are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Cervical pyomyositis is reported as rare with only six separate cases reported in the world since 1992 with the most recent in February 2016. However, within a year, we have succeeded in collecting the first case series of cervical pyomyositis in Sungai Buloh Hospital. Objective: To study 5 cases of cervical pyomyositis presented in Sungai Buloh Hospital and to discuss the appropriate management Design: Case series. Case presentation: We report 5 cases of cervical pyomyositis presented in Sungai Buloh Hospital in 2015.Three out of five cases were immunocompetent patients and most of them come from low socioeconomic background. They presented with unilateral neck swelling, pain and fever. Computed tomography of the neck showed intramuscular sternocleidomastoid muscle abscess and there was only one patient has involvement of masseter muscle. In this case series, there were multiorganism isolated such as Staphylococcus Aureus, Klebsiella species, Streptococcus Pyogenes. Four underwent incision and drainage and one patient had ultrasound guided drainage. Concurrently, they were all treated with intravenous cefuroxime and metronidazole. Duration of stay was four to thirteen days. All of them well postoperatively and continued to do well when reviewed later in the clinic. Discussion: Cervical pyomyositis has been reported as a rare condition thus far however our case series proves otherwise. The common denomination which all patients shared was their socioeconomically background. Computed tomography scan was crucial in obtaining a diagnosis and to delineate the extension of intramuscular abscess which was important for surgical intervention. Delayed diagnosis has been reported to cause internal jugular vein thrombosis, sepsis and death. Fortunately, our case series show that treatment with intravenous antibiotics and drainage of the abscess was adequate without any untoward complications. Conclusion: We should consider cervical pyomyositis in any painful swelling in head and neck region as it is no longer as rare as reported especially when patients are from a lower socioeconomical background.

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