SHM Converge Scientific Abstract ePoster Gallery-Pulmonary Nodules: A Presentation of Occult Pyomyositis

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A 44-year-old man with obstructive sleep apnea, alcohol use disorder, and prior nasal/tonsillar surgery presented with generalized weakness, body aches, and headache. Initial evaluation showed he was afebrile and stable, with normal EKG and chest X-ray. CT angiogram ruled out pulmonary embolism but revealed multiple pulmonary nodules concerning for inflammatory or neoplastic disease. CT abdomen showed only fatty liver and a small abdominal wall hernia.<br /><br />He later developed fever, and blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Transthoracic and transesophageal echocardiograms showed normal cardiac function and no endocarditis or abscess. On further questioning, he reported mild right lateral thigh discomfort. Exam was largely unrevealing, but CT of the femur showed muscle edema. MRI demonstrated a multiloculated intramuscular abscess in the right quadriceps, with the largest collection measuring 6.3 cm.<br /><br />The patient underwent surgical incision and drainage of the thigh abscess. Culture from the abscess confirmed MSSA, and antibiotics were narrowed to cefazolin. Repeat blood cultures became negative, and he completed four weeks of antibiotic therapy.<br /><br />This case highlights occult pyomyositis as a source of MSSA bacteremia and septic pulmonary nodules. Although septic pulmonary emboli are more commonly linked to endocarditis, intravenous drug use, central lines, or prosthetic valves, deep soft tissue infection can also cause pulmonary nodules. Clinicians should consider pyomyositis in patients with bacteremia and pulmonary nodules, even when classic local signs of infection are absent.

Asset Subtitle

Gurpinder Singh

Meta Tag

Author List Gurpinder Singh, Jaspreet Kaur, Sahibjot Kaur Sandhu, Sharan Sharma

Category Clinical Vignettes

Concept Pyomyositis

Concept Bacteremia

Concept Staphylococcus aureus

Concept Septic Pulmonary Nodule

Concept Methicillin-Susceptible Staphylococcus aureus

Distinguished Non-Finalist

Presenter Organization Concord Hospital, Laconia, NH

Presenting Author Gurpinder Singh

Track Adult

Keywords

MSSA bacteremia

pyomyositis

intramuscular abscess

septic pulmonary nodules

septic emboli

quadriceps abscess

Staphylococcus aureus

cefazolin

blood cultures

MRI diagnosis

Pyomyositis

Bacteremia

Staphylococcus aureus

Septic Pulmonary Nodule

Methicillin-Susceptible Staphylococcus aureus