Acute Proximal Myopathy in a Young Male-A Case of Infectious Myositis

• Published in: Medicina (Kaunas, Lithuania) Vol. 55; no. 1; p. 19
• Main Authors: Dhital, Rashmi, Basnet, Sijan, Poudel, Dilli Ram
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 17-01-2019; MDPI AG
• Subjects: Acute Disease; Adult; Aftercare; Anti-Bacterial Agents - therapeutic use; Case Report; Delayed Diagnosis; Diabetes Complications; Diagnosis, Differential; Emergency Service, Hospital; Humans; infectious myositis; Length of Stay; Magnetic Resonance Imaging; Male; Muscle Weakness - diagnosis; Muscle Weakness - diagnostic imaging; Myalgia - diagnosis; Myalgia - diagnostic imaging; myopathy; Myositis - diagnosis; Myositis - diagnostic imaging; Myositis - drug therapy; Myositis - etiology; Risk Factors; Staphylococcal Infections - urine; Thigh - diagnostic imaging; Thigh - physiopathology; Treatment Outcome; Urinary Tract Infections - diagnosis; Urinary Tract Infections - drug therapy; Urinary Tract Infections - urine; infectious myositis; myopathy
• ISSN: 1648-9144; 1010-660X; 1648-9144; 1010-660X
• DOI: 10.3390/medicina55010019

: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context.
: A 40-year-old male with diabetes presented with exquisite pain and weakness of proximal extremities. He denied trauma, recent travel, new medications, or substance use. He denied prior rheumatologic, thyroid, or musculoskeletal disorders. The urine culture revealed staphylococcal infection with negative blood cultures. Rheumatologic and endocrine workups were negative. Random muscle biopsy was negative for inflammatory infiltrate. MRI of thighs and arms showed innumerable foci of nodular and ring enhancement in the proximal muscle groups. The patient noted improvement after about 10 days of antibiotics with complete resolution at 2 months.
: Bacterial myositis is most often due to
(70%) and affects a single muscle. Multifocal abscesses are rare and strongly suggest transient bacteremia. Our patient most likely had transient initiating staphylococcal bacteremia leading to diffuse myositis and hematogenous urinary tract infection (UTI). A delay in treatment can be life-threatening.