Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease - A Case Report and Literature Review

Barros, Antônio Augusto Guimarães; Soares, Cláudio Beling Gonçalves; Temponi, Eduardo Frois; Barbosa, Victor Atsushi Kasuya; Teixeira, Luiz Eduardo Moreira; Grammatopoulos, George

doi:10.1016/j.rboe.2017.09.005

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Case Report • Rev. bras. ortop. 54 (02) • Mar-Apr 2019 • https://doi.org/10.1016/j.rboe.2017.09.005 copy

Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease - A Case Report and Literature Review^* * Work performed in the Hospital Madre Teresa, Belo Horizonte, MG, Brazil in association with The Ottawa Hospital, Ottawa, Canada.

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Abstract

Primary pyomyositis is a deep bacterial infection of the skeletal muscle. If left undiagnosed and untreated, the infection spreads, leading to sepsis, septic shock, and even death. The authors report a 23-year-old female presenting with piriformis pyomyositis during a treatment for Kikuchi-Fujimoto disease. Pyomyositis is a rare but potentially severe infection, which can lead to septic shock. The present case shows the need for a high degree of clinical suspicion for patients with compromised immune systems to begin treatment at an early stage. The literature demonstrates that outcomes of the treatment of piriformis pyomyositis are good.

Keywords:
pyomyositis; staphylococcus aureus; histiocytic necrotizing lymphadenitis

Authors	Number of cases	Age (years)	Management	Outcome
Burkhart et al³3 Burkhart BG, Hamson KR. Pyomyositis in a 69-year-old tennis player. Am J Orthop 2003;32(11):562-563	1	69	CT-guided aspiration	Full resolution of symptoms and return to sporting activities.
Chusid et al⁴4 Chusid MJ, Hill WC, Bevan JA, Sty JR. Proteus pyomyositis of the piriformismuscle ina swimmer. Clin Infect Dis 1998;26(01):194-195	1	17	Intravenous antibiotics	By day 10 of treatment, the inflammatory markers of the patient returned to normal.
Wong et al⁵5 Wong CH, Choi SH, Wong KY. Piriformis pyomyositis: a report of three cases. J Orthop Surg (Hong Kong) 2008;16(03):389-391	3	45	Intravenous antibiotics	The pain gradually subsided and inflammatory markers returned to normal.
		58	CT-guided aspiration	Fever and pain subsided after drainage and 2 weeks of intravenous antibiotics.
		71	Intravenous antibiotics	The pain and fever subsided and the myositis resolved after 2 weeks of intravenous antibiotics.
Wong et al⁶6 Wong LF, Mullers S, McGuinness E, Meaney J, O'Connell MP, Fitzpatrick C. Piriformis pyomyositis, an unusual presentation of leg pain post partum-case report and review of literature. J Matern Fetal Neonatal Med 2012;25(08):1505-1507	1	31	Intravenous antibiotics	Blood parameters and clinical symptoms improved throughout the course of the treatment.No residual symptoms.
Chong et al⁷7 Chong KW, Tay BK. Piriformis pyomyositis: a rare cause of sciatica. Singapore Med J 2004;45(05):229-231	1	30	Intravenous antibiotics	A follow-up visit in the clinic showed full recovery with normalized ESR and CRP.
Toda et al⁸8 Toda T, Koda M, Rokkaku T,Watanabe H, Nakajima A, Yamada T, et al. Sciatica caused by pyomyositis of the piriformis muscle in a pediatric patient. Orthopedics 2013;36(02):e257-e259	1	06	Oral antibiotics	Final follow-up at 6 months revealed full range of motion of the hip joint with no pain.
Koda et al⁹9 Koda M, Mannoji C,Watanabe H, Nakajima A, Yamada T, Rokkaku T, et al. Sciatica caused by pyomyositis of the piriformis muscle. Neurol India 2013;61(06):668-669	1	42	Open surgical drainage followed by antibiotic treatment	Dramatic relief of pain after the surgery.Patient returned to work after 2 months.
Giebaly et al¹⁰10 Giebaly DE, Horriat S, Sinha A, Mangaleshkar S. Pyomyositis of the piriformis muscle presenting with sciatica in a teenage rugby player. BMJ Case Rep 2012;2012:bcr1220115392. Doi: 10.1136/ bcr.12.2011.5392 https://doi.org/10.1136/...	1	18	Intravenous antibiotics	Full resolution of symptoms and return to sporting activities after 6 months.
Colmegna et al¹¹11 Colmegna I, Justiniano M, Espinoza LR, Gimenez CR. Piriformis pyomyositis with sciatica: an unrecognized complication of "unsafe" abortions. J Clin Rheumatol 2007;13(02):87-88	1	18	CT-guided aspiration	After 4 weeks, the patient was fully recovered.
Kinahan et al¹²12 Kinahan AM, Douglas MJ. Piriformis pyomyositis mimicking epidural abscess in a parturient. Can J Anaesth 1995;42(03): 240-245	1	22	Intravenous antibiotics	Full recovery after 6 weeks of intravenous antibiotic therapy.
Gaughan et al¹³13 Gaughan E, Eogan M,Holohan M. Pyomyositis after vaginal delivery. BMJ Case Rep 2011;2011:bcr0420114109. Doi: 10.1136/bcr.04. 2011.4109 https://doi.org/10.1136/bcr.04...	1	34	Intravenous antibiotics	After 8 weeks, the patient was still using crutches to mobilize and was still reliant on analgesics.
(current case)	1	23	Open surgical drainage followed by antibiotic treatment	Asymptomatic after 6 months.

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[1] Address for correspondence
Antônio Augusto Guimarães Barros, Hospital Madre Teresa, Belo Horizonte, MG, Brazil (e-mail: antonioagbarros@gmail.com).

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Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease - A Case Report and Literature Review* * Work performed in the Hospital Madre Teresa, Belo Horizonte, MG, Brazil in association with The Ottawa Hospital, Ottawa, Canada.

Abstract

Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease - A Case Report and Literature Review^* * Work performed in the Hospital Madre Teresa, Belo Horizonte, MG, Brazil in association with The Ottawa Hospital, Ottawa, Canada.