References
Meticillin-susceptible Staphylococcus aureus pyomyositis and cellulitis in right thigh of a 15-year-old boy: a case study
Abstract
Pyomyositis is a purulent infection of striated muscle and postoperative management remains the mainstay. If delayed primary wound closure is not managed in a timely manner, it often results in recurrent infection and sinus tract creation. Cavity wounds with sinus formation are known to complicate treatment, are problematic to manage and persist for long periods of time. The aim of this case report is to present the challenges in the assessment and management of a sinus tract with deep cavity wound, between the vastus lateralis and biceps femoris muscles, originating from liquefaction of a haematoma. Our review of the literature revealed limited research evidence in the management of deep cavity wounds. This is a rare case where the sinus tract route which leads to the rim-shaped cavity is embedded deep between the muscles, posing a high risk of recurrent infection from the premature closure of the wound tract. Successful management was attributed to: the accuracy in the initial wound assessment; appropriate dressing plans; the rationale for each action; and an outcome goal as each treatment progressed. Daily dressing change and reassessment of the wound was required to ensure progress and to address any complications in a timely manner. Finally, concerns of the patient and their family and regular discussions on the treatment plans are important to encourage adherence with management goals.
Pyomyositis has a predilection for large muscle groups and often results in localised abscess formation. Pyomyositis usually affects the muscles of the lower limb and thigh region, quadriceps, iliopsoas and gluteal muscles.1,2Staphylococcus aureus is the most common pathogen in children, followed by β-haemolytic Streptococcus group A, Escherichia coli and Enterococcus.3,4 In approximately 90% of cases of pyomyositis in tropical areas, meticillin-susceptible Staphylococcus aureus (MSSA) was found in purulent material.5 The proposed risk factors and pathogenesis include intensive exercise and local trauma, malnutrition, viral and parasitic infections, bacteraemia, immunodeficiency or chronic illness.6,7
Symptoms generally begin insidiously, with low-grade fever, muscle ache and cramping, evolving over several days. About 25% of patients experience multiple abscesses. In the early stage, examination may reveal only a hard, rubbery firmness to the muscle belly, with no other superficial signs of inflammation. Within three weeks of initial infection, boggy swelling, erythema, tenderness and warmth appear, and the lesion becomes fluctuant.8
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