Diabetic Pyomyositis
An uncommon cause of a painful leg
- Michele Y.Y. Seah, MBBS1,
- Sadanand N. Anavekar, MBBS, FRACP, FCP, PHD1,
- Judy A. Savige, MB BS, FRCP, FRACP, FRCPA, PHD, MSC2 and
- Louise M. Burrell, MBCHB, MRCP, MD, FRACP, FAHA1
- 1Department of Medicine, University of Melbourne, Austin Health, Heidelberg Heights, Victoria, Australia
- 2Department of Medicine, The Northern Hospital, Epping, Victoria, Australia
- Address correspondence and reprint requests to Louise M. Burrell, Building 24, Department of Medicine, University of Melbourne, Heidelberg Repatriation Hospital, Victoria 3081, Australia. E-mail: l.burrell{at}unimelb.edu.au
An uncommon cause of a painful leg
Pyomyositis is a pyogenic infection of the skeletal muscle that can lead to abscess formation (1,2). It commonly occurs in the tropics, but is also recognized in temperate climates, with HIV infection and diabetes being the main predisposing factors (3,4). The diagnosis of pyomyositis is difficult due to its vague clinical presentation and poor localizing signs. Early in its course, the differential diagnosis includes musculoskeletal aches, osteomyelitis, septic arthritis, muscle hematoma, muscle rupture, thrombophlebitis, or deep venous thrombosis. A delay in diagnosis may result in compartment syndrome, sepsis, and death. The long-term sequelae of pyomyositis include osteomyelitis of adjacent bones, muscle scarring, prolonged hospitalization, and significant functional impairment (5). We report a patient with diabetes who presented with a painful leg and was diagnosed with pyomyositis.
RESEARCH DESIGN AND METHODS
A 63-year-old man with type 2 diabetes presented with a 1-week history of increasing pain and swelling over his left lower limb. He was unable to weight-bear and had systemic features of malaise, fever, and rigors. There was no history of trauma. Comorbidities included ischemic heart disease, hypertension, …
