Pyomyositis associated with abscess formation caused by streptococcus pneumoniae in children: a case report and review of literature

Table 1 Cases of pyomyositis by Streptococcus Pneumonia in children in literature

Age (y)	22 days	8 Mo	2	3	4	12	13	13	12 (present report)
Sex	M	M	M	M	M	M	F	F	F
Preceding or association illness	None	Meningitis	Otitis Media	None	Pneumonia	None	Trauma	Trauma	None
Underling condition	None	None	None	None	C3 complement deficency	None	Unknown	None	None
Positive abscess colture	Yes	No	Yes	Yes	Yes	No	Yes	No	No
Positive blood colture	No	Yes	No	No	No	Yes	No	Yes	Yes
Muscles involved	Ileopsoas	Quadricipes femoris	Biceps Brachialis	Subscapularis, Gluteus minimus	Ileopsoas	Iliacus, Piriformis, Gluteus Maximum, gluteus medium	Ileopsoas	Ileopsoas	iliacus, piriformis, internal shutter
White blood cell (x10^9/L)	36,7	18,3	28		28	64		19,7	11,07
Neutrophilis (%)	Unknown	58	64		75	78			90
CRP (mg/dl)	26,4	35,8	4,43		22,9	16,83			42
Erythrocyte sedimentation rate (mm/h)						58		126
Diagnostic Imaging	CT	Ultrasound, MRI	Ultrasound, MRI	CT	Ultrasound, MRI	MRI	CT	MRI	Ultrasound, MRI
Antibiotics treatment	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Type of antibiotics	Ampicillin	Penicillin + Clindamycin	Cefuroxime + clindamycin	Cefazolin	Ampicillin	Clindamycin	Unknown	Cefazolin	Ceftriaxone
Duration of IV tratment (days)	28	10	30		21	21		21	21
Recovery	Yes	Yes	Yes		Unknown	Yes		Yes	Yes
Abscess drainage	Yes	No	Yes	Yes	Yes	No	Yes	No	No
Complication	None	None	None	None	None	None	None	None	None

The youngest patient was 22 days old. In two cases, preceding trauma was documented. In three children, pyomyositis was associated with otitis media, pneumonia, and meningitis. In one case, the patient had an immune defect (C3 complement deficiency. In five cases, Streptococcus pneumoniae was isolated from the abscess culture and in four cases from blood culture, including the present case report. The average white blood cell count was 25,72 × 109/L with a prevalence of neutrophils. The mean C-Reactive Protein was 24,72 mg/dl. More than one muscle was implicated in 33% of cases. The main diagnostic method used was Magnetic Resonance Imaging (MRI) in six cases, following by ultrasound (4 cases, all associated with MRI) and Computer Tomography (CT) (3 cases). All patients were treated with antibiotics; in four cases, first- and third generation cephalosporins were used, followed by clindamycin (3 cases) and penicillin (3 cases). The mean duration of intravenous antibiotic therapy was 21 days. In 5 cases, antibiotic therapy was associated with drainage of abscess formation. None of the patients experienced any long-term complications with complete resolution.
MRI (magnetic resonance imaging), CT (computed tomography), IV (intravenous), RCP (C-reactive-protein). Cases of pyomyositis by Streptococcus Pneumonia in children in literature

ISSN: 1824-7288