SHM Converge Scientific Abstract ePoster Gallery-Gauzed and Confused

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A 42-year-old man with well-controlled HIV on antiretroviral therapy presented with worsening left hip pain and swelling after a recent baseball tournament, along with other minor injuries. He had been diagnosed twice previously with muscle strain. On arrival to the outside hospital and later to the receiving hospital, he was tachycardic, tachypneic, febrile, and had marked leukocytosis. Initial MRI suggested necrotizing fasciitis, prompting broad-spectrum antibiotics and transfer.<br /><br />Further evaluation showed that the left hip was erythematous and painful with decreased range of motion, and the right shoulder was also swollen and tender. Imaging ultimately revealed left gluteal and psoas abscesses rather than necrotizing fasciitis. He underwent aspiration and surgical drainage of the right shoulder and left hip/pelvic abscesses. The right shoulder contained subdeltoid pus without joint involvement, while the left hip, gluteal, and psoas collections involved the hip joint. Blood and surgical cultures grew methicillin-sensitive Staphylococcus aureus.<br /><br />The case highlights pyomyositis, a skeletal muscle infection believed to arise from transient bacteremia in the setting of muscle injury. It is increasingly recognized in temperate climates, especially among immunocompromised patients such as those with HIV. Risk factors include trauma, immunosuppression, diabetes, malignancy, and intravenous drug use. Pyomyositis commonly presents with fever and localized muscle pain and may progress from early muscle inflammation to abscess formation and then bacteremia with metastatic infection. Complications can include septic arthritis, endocarditis, and septic emboli.<br /><br />This case emphasizes that pyomyositis can be mistaken for muscle strain, cellulitis, septic arthritis, or necrotizing fasciitis, and should be considered in immunocompromised patients with localized muscle pain.

Asset Subtitle

Michael J. Bradley

Meta Tag

Author List Michael J. Bradley, Pete Meliagros, Timothy R. Ford

Category Clinical Vignettes

Concept Pyomyositis

Concept Immunocompromised State

Concept Methicillin-Sensitive Staphylococcus aureus

Concept Methicillin-Resistant Staphylococcus aureus

Concept Fever

Distinguished Non-Finalist

Presenter Organization VCU Health

Presenting Author Michael J. Bradley

Track Adult

Keywords

pyomyositis

HIV

methicillin-sensitive Staphylococcus aureus

gluteal abscess

psoas abscess

hip pain

muscle strain

necrotizing fasciitis

septic arthritis

immunocompromised

Pyomyositis

Immunocompromised State

Methicillin-Sensitive Staphylococcus aureus

Methicillin-Resistant Staphylococcus aureus

Fever