Images in Clinical Rheumatology
Pyomyositis presenting as septic arthritis
Artritis séptica como forma de inicio de una piomiositis
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Brandy-García, Daniel Clemente Garulo, Juan Carlos López Robledillo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Anahy M." "apellidos" => "Brandy-García" "email" => array:1 [ 0 => "anahymbg@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Daniel" "apellidos" => "Clemente Garulo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Juan Carlos" "apellidos" => "López Robledillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología Pediátrica, Hospital Universitario Niño Jesús, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis séptica como forma de inicio de una piomiositis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 882 "Ancho" => 2000 "Tamanyo" => 148476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MR imaging of the left knee, STIR sequences with intravenous contrast (IVC). (A) Sagittal slice. (B) Coronal slice. (C) Transversal slice. Major synovitis is observed which affects the suprapatellar bursa (arrows) and muscular hyperintensity of the internal and external vastus lateralis muscles. Compatible with pyomyositis (star).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pyomyositis is an acute bacterial infection of the striated muscle which is occasionally accompanied by the formation of abcesses<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> not secondary to adjacent infection of the skin or bone. Its association with septic arthritis is exceptional.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a two-year-old child with no remarkable medical history who presented with left gonalgia of major functional limitation of 20 days onset, who was stated to have suffered trauma and a catarrhal process the previous week.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Examination revealed fever and swelling of the left knee. Arthrocentesis was performed with the obtainment of 10<span class="elsevierStyleHsp" style=""></span>cc of synovial fluid of purulent appearance (46,830/mm<span class="elsevierStyleSup">3</span> leukocytes, 91% PML, glucose 47<span class="elsevierStyleHsp" style=""></span>mg/dl and culture both for bacteria, fungus and mycobacteria testing negative). Haemogram tests, biochemistry, chest X-ray and haemocultures were normal or negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">MR of the left knee was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) which revealed synovitis and an extensive hyperintense imaging in the STIR sequences with homogeneic enhancement after the administration of intravenous contrast (IVC) in internal and external vessel, compatible with pyomyositis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Antibiotic treatment was initiated with endovenous cloxacillin and cefotaxime with progressive improvement of clinical and radiological symptoms (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Pyomyositis in immunocompetent individuals is typical in tropical areas, with the most frequent microorganism being <span class="elsevierStyleItalic">Staphylococcus aureus</span> (70%–90%).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In our environment it is unusual, and may be suspected in the light of a background of trauma, intensive physical exercise or chronic diseases (such as diabetes mellitus or neoplasms),<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> with positivity in cultures being almost exceptional (5%–33%).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It is more common when affecting large sized muscles.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Diagnosis timing conditions prognosis since this is usually withheld due to low suspicion.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Imaging tests are essential, with MR being the technique with the highest sensitivity and specificity for the identification of early forms.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Intensive early antibiotic treatment reduces physical sequelae.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-01-10" "fechaAceptado" => "2018-02-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Brandy-García AM, Clemente Garulo D, López Robledillo JC. Artritis séptica como forma de inicio de una piomiositis. Reumatol Clin. 2020;16:247–248.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 882 "Ancho" => 2000 "Tamanyo" => 148476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MR imaging of the left knee, STIR sequences with intravenous contrast (IVC). (A) Sagittal slice. (B) Coronal slice. (C) Transversal slice. Major synovitis is observed which affects the suprapatellar bursa (arrows) and muscular hyperintensity of the internal and external vastus lateralis muscles. Compatible with pyomyositis (star).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1218 "Ancho" => 900 "Tamanyo" => 69327 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MR of the left knee, STIR sequences with IVC, sagittal slice. No findings of interest.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyomyositis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Gubbay" 1 => "M.D. Issacs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006454-200010000-00015" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2000" "volumen" => "19" "paginaInicial" => "1009" "paginaFinal" => "1012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11055607" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyomyositis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Verma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Curr Infect Dis Rep" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "12" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyomyositis due to <span class="elsevierStyleItalic">Salmonella enteritidis</span> in an immunocompetent patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Clemente Garulo" 1 => "M.D. López Saldaña" 2 => "J. Álvarez Coca" 3 => "L. Alonso Canal" 4 => "J.C. López Robledillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2010" "volumen" => "73" "paginaInicial" => "108" "paginaFinal" => "109" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of pyomyositis in children: 20-year experience in a medical center in Taiwan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.C. Chiu" 1 => "M.C. Hsieh" 2 => "H. Chi" 3 => "F.Y. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Microbiol Immunol Infect" "fecha" => "2009" "volumen" => "42" "paginaInicial" => "469" "paginaFinal" => "479" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contribution of imaging to the evaluation of pyomyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Boniotti" 1 => "N. Carlone" 2 => "G. Perboni" 3 => "R. Caudana" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Radiol Med" "fecha" => "2005" "volumen" => "109" "paginaInicial" => "404" "paginaFinal" => "413" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15883525" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001600000003/v1_202006131316/S2173574319300711/v1_202006131316/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000003/v1_202006131316/S2173574319300711/v1_202006131316/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300711?idApp=UINPBA00004M" ]
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