Annals of Indian Academy of Neurology
IMAGES IN NEUROLOGY
Year
: 2017  |  Volume : 20  |  Issue : 1  |  Page : 58-

Nocardial pyomyositis


Boby Varkey Maramattom1, Rony K Varghese1, Anila Sudhakaran2, Kurian Ninan3,  
1 Department of Neurology, Aster Medcity, Kochi, Kerala, India
2 Department of Emergency Medicine, Aster Medcity, Kochi, Kerala, India
3 Department of Radiology, Aster Medcity, Kochi, Kerala, India

Correspondence Address:
Boby Varkey Maramattom
Department of Neurology, Aster Medcity, Kothad, Kochi - 682 027, Kerala
India




How to cite this article:
Maramattom BV, Varghese RK, Sudhakaran A, Ninan K. Nocardial pyomyositis.Ann Indian Acad Neurol 2017;20:58-58


How to cite this URL:
Maramattom BV, Varghese RK, Sudhakaran A, Ninan K. Nocardial pyomyositis. Ann Indian Acad Neurol [serial online] 2017 [cited 2020 Apr 8 ];20:58-58
Available from: http://www.annalsofian.org/text.asp?2017/20/1/58/199915


Full Text

A 70-year-old male with Type II diabetes underwent plasmapheresis through the internal jugular vein 2 months ago for chronic inflammatory demyelinating polyneuropathy. Subsequently, he was on high-dose prednisolone and azathioprine. He presented to the emergency department with severe right thigh pain for 2 weeks. Examination revealed a fluctuant tender swelling of 4 cm × 7 cm size in the upper anterior thigh and antalgic weakness of adduction of right thigh. Ultrasound showed a well-defined intramuscular cystic lesion in the medial aspect of the right thigh measuring 8 cm × 4 cm. Magnetic resonance imaging showed a well-circumscribed ovoid-shaped T2-weighted homogenously hyperintense and T1-weighted hypointense lesion in the right adductor longus muscle, measuring 5.4 cm × 4.2 cm × 8.7 cm [Figure 1]. The lesion showed avid peripheral enhancement and thin enhancing septae and did not encase the underlying femoral artery. Ultrasound-guided aspiration revealed frank pus. Gram smear [Figure 2] and culture showed Gram-positive filamentous bacteria which were weakly acid fast (Nocardia sp.). He was initiated on treatment with trimethoprim-sulfamethoxazole for 3 months with good improvement.{Figure 1}{Figure 2}

Pyomyositis (tropical pyomyositis) is an uncommon primary infection of skeletal muscles. Seventy-five percent of cases occur in immunocompromised individuals, the thigh being a common site.[1] Staphylococcus aureus (90%) accounts for the majority of cases. Nocardial pyomyositis is extremely rare but responds well to treatment if initiated early.[2] Skeletal muscles are very resistant to infection; however, our patient could have developed nocardial pyomyositis from transient bacteremia during plasmapheresis as there was no evidence of systemic nocardiosis.

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Conflicts of interest

There are no conflicts of interest.

References

1Agarwal V, Chauhan S, Gupta RK. Pyomyositis. Neuroimaging Clin N Am 2011;21:975-83.
2Sagar V, Pinto B, Lal A, Kumar M, Rathi M, Sharma K, et al. Nocardia pyomyositis in a patient with granulomatosis with polyangiitis. Int J Rheum Dis 2015. doi: 10.1111/1756-185X.12623. [Epub ahead of print].