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IMAGES IN NEUROLOGY |
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| Year : 2017 | Volume
: 20
| Issue : 1 | Page : 58 |
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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
| Date of Submission | 20-Oct-2016 |
| Date of Decision | 23-Nov-2016 |
| Date of Acceptance | 15-Dec-2016 |
| Date of Web Publication | 9-Feb-2017 |
Correspondence Address:
Boby Varkey Maramattom
Department of Neurology, Aster Medcity, Kothad, Kochi - 682 027, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-2327.199915
How to cite this article:
Maramattom BV, Varghese RK, Sudhakaran A, Ninan K. Nocardial pyomyositis. Ann Indian Acad Neurol 2017;20:58 |
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: (a) Ultrasound showing 8 cm × 4 cm cystic lesion. (b) Coronal T1-weighted magnetic resonance imaging. (c) Axial T2 magnetic resonance imaging. (d) Axial T1 with contrast. A well-circumscribed ovoid-shaped altered signal intensity lesion in the right adductor longus muscle
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 | Figure 2: (a) Gram stain and (b) 1% acid-fast stain showing filamentous bacteria
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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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Agarwal V, Chauhan S, Gupta RK. Pyomyositis. Neuroimaging Clin N Am 2011;21:975-83.  |
| 2. | Sagar 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]. |
[Figure 1], [Figure 2]
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| Sydney Tatsuno, Tara Reed, Eric Tatsuno, Curtis Lee | | BMJ Case Reports. 2020; 13(9): e233415 | | [Pubmed] | [DOI] | |
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