Elsevier

Journal of Pediatric Surgery

Volume 44, Issue 11, November 2009, Pages 2173-2178
Journal of Pediatric Surgery

Original article
Pyomyositis in children: early diagnosis and treatment

https://doi.org/10.1016/j.jpedsurg.2009.02.053Get rights and content

Abstract

Purpose

This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis.

Methods

Between 2001 and 2006, 6 children with a mean age of 7.2 years were diagnosed and treated for pyomyositis in our clinic. The most common site of involvement was the hip and thigh region. All patients underwent early magnetic resonance imaging (MRI) examination that played a significant role in the early diagnosis and management of the disease.

Results

Staphylococcus aureus was the most common pathogen and was identified in 3 cases. Intravenous antibiotics were administered and were followed by oral agents for an additional period. The duration of therapy ranged from 3 to 6 weeks. No surgical intervention was needed. Magnetic resonance imaging was used to evaluate response to the therapy.

Conclusions

Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis.

Section snippets

Materials and methods

Between 2001 and 2006, 6 children (3 boys and 3 girls) were diagnosed and treated for pyomyositis (Table 1). Patient's medical records and imaging studies were retrospectively evaluated. This included an assessment of presenting symptoms, clinical findings, duration from the onset of symptoms to diagnosis, laboratory data, imaging studies, clinical course, and outcome.

At the time of presentation, the mean age of patients was 7.2 years (range, 3-14 years). In 3 patients, there was a history of

Results

None of the patients required surgical intervention. No patient underwent drainage, surgical or percutaneous. All patients were treated conservatively with intravenous antibiotics. A combination of dicloxacillin and cefuroxime was started as empiric therapy. Treatment was modified according to the sensitivity results of the culture tests. The duration of therapy ranged from 3 to 8 weeks.

In the invasive and early purulent stages, affected muscles were enlarged and showed homogenous intermediate

Discussion

Pyomyositis is a primary bacterial infection involving the skeletal muscles. It is known as an entity endemic to the tropical area and is often referred as pyomyositis tropicans [1]. Levin et al [5] reported the first case that occurred in high temperature climates. Today, pyomyositis has become more prevalent [2], [6].

Diagnosis of pyomyositis is often delayed because of the vague presentation. A mean delay of 10 days from the onset of the symptoms to correct diagnosis has been reported in the

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