fosfomycin and Myositis

A 5-year-old girl was hospitalised for fever, abdominal and lumbar pain, associated with general impairment state and a whitlow. One of the blood cultures and CSF grew A beta haemolytic Streptococcus, muscular echography and MRI showed paravertebral myositis, which was complicated by an epidural abscess. The outcome was good with medical treatment alone.. Streptococcal myositis is a rare and severe skeletal muscle infection caused by A beta haemolytic Streptococcus. It is characterized by a muscle necrosis, without abscess formation. It has to be distinguished from pyomyositis, usually caused by Staphylococcus aureus, where a muscle abscess occurs, which must be treated by surgical drainage and antibiotics. Prognosis of this infection is poorer than other muscle infections such as pyomyositis, with a high mortality rate. The diagnosis is difficult and often delayed. Practitioners should keep in mind this diagnosis, even if symptoms are non specific, in front of an undetermined infectious syndrome associated with pain, and make an echography or nuclear magnetic resonance imaging to confirm the diagnosis.

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Drug Therapy, Combination; Epidural Abscess; Female; Follow-Up Studies; Fosfomycin; Humans; Magnetic Resonance Imaging; Myositis; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Treatment Outcome; Ultrasonography

We report a rare case of pyomyositis in a 28-year-old Japanese woman who was not immunocompromised. She was admitted because of high fever, sore throat, and severe tenderness and swelling of the right calf. Redness, swelling, and tenderness indicated presence of acute inflammation in the calf. CT of the lower extremities demonstrated low density areas in the right soleus muscle and surrounding fascia with marked swelling, which were of high signal on T2 weighted images of MRI. There was no finding of abscess formation. A tentative clinical diagnosis of acute pyomyositis was made, and antibiotics therapy with a combination of fosfomycin and sulbactam/cefoperazone was started although the arterial blood culture was negative for bacteria. Associated acute tonsilitis was the most probable focus of pyomyositis. Antibiotics relieved her symptoms, and the inflammation subsided in several weeks. No surgical procedure was necessary. MRI taken tree weeks after the onset demonstrated abscess formation between the soleus and gastrocnemius muscles. Slight high intensity indicating scar formation remained in the area of the former abscess six weeks after the onset. MRI was very useful not only in making the early diagnosis but also in the follow-up of pyomyositis.

Topics: Adult; Cefoperazone; Drug Therapy, Combination; Female; Fosfomycin; Humans; Magnetic Resonance Imaging; Muscle, Skeletal; Myositis; Sulbactam; Tomography, X-Ray Computed