Volume 8 | Issue 1 | January-April 2022 | Page: 02-07 | Archan Desai, Ashish Ranade, Mohan V. Belthur, Sandeep Patwardhan, Gauri A. Oka
Authors: Archan Desai , Ashish Ranade [1, 2], Mohan V. Belthur , Sandeep Patwardhan , Gauri A. Oka 
 Department of Orthopaedics, Bharati Hospital and Research Centre, Pune, Maharashtra, India.
 Department of Orthopaedics, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India.
 Department of Child Health & Orthopaedics, University of Arizona College of Medicine-Phoenix, USA.
 Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.
Address of Correspondence
Dr. Ashish Ranade,
Consultant Paediatric Orthopaedic Surgeon, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India. Visiting Pediatric Orthopaedic Surgeon, Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
Pyomyositis in children is an uncommon bacterial infection of skeletal muscles which has more frequently been described in tropical areas, but it is becoming increasingly recognized in temperate climates too. Any muscle group in the body can be involved, but it commonly affects the large muscle groups which are located around the pelvic girdle and lower extremities. Clinical presentation is very similar to septic arthritis of the hip and needs to be diagnosed early. MRI is the investigation of choice. Depending on the severity this condition, it can be treated conservatively with antibiotics in its early stage and with percutaneous or formal incision and drainage in later stages. Generally, if it is diagnosed early, good outcomes can be expected.
Keywords: Pelvic Pyomyositis, Septic arthritis, Infection, Magnetic resonance imaging
1. Bickels J, Ben-Sira L, Kessler A, Wientroub S. Primary pyomyositis. J Bone Joint Surg Am. 2002; 84(12):2277-2286.
2. Anand SV, Evans KT. Pyomyositis. Br J Surg. 1964; 51:917-920.
3. Levin MJ, Gardner P, Waldvogel FA. An un-usual infection due to staphylococcus aureus. N Engl J Med. 1971; 284(4):196-198.
4. Ciampi MA, Sadigh M, Sherwood JA, Protopapas Z, Thornton GF, Andriole VT. Temperate pyomyositis at two community hos-pitals. Infect Dis Clin Pract. 1998; 7:265-273.
5. Chiedozi LC: Pyomyositis: review of 205 cases in 112 patients, Am J Surg 137:255, 1979
6. De Boeck H, Noppen L, Desprechins B: Pyomyositis of the adductor muscles mimicking an infection of the hip. Diagnosis by magnetic resonance imaging: a case report, J Bone Joint Surg Am 76:747, 1994.
7. Hernandez RJ, Strouse PJ, Craig CL, et al: Focal pyomyositis of the perisciatic muscles in children, AJR Am J Roentgenol 179:1267, 2002.
8. Kadambari D, Jagdish S: Primary pyogenic psoas abscess in children, Pediatr Surg Int 16:408, 2000.
9. Orlicek SL, Abramson JS, Woods CR, et al: Obturator internus muscle abscess in children, J Pediatr Orthop 21:744, 2001.
10. Garcia-Mata S, Hidalgo-Ovejero A, Esparza-Estaun J. Primaryobturator-muscle pyomyositis in immunocompetent children. JChild Orthop. 2012;6:205–15.
11. Taksande A, Vilhekar K, Gupta S. Primary pyomyositis in a child. Int J Infect Dis. 2009;13(4):e149–51.
12. Christin L, Sarosi GA. Pyomyositis in North America: case reports and review. Clin Infect Dis. 1992;15:668–77.
13. Crum NF (2004) Bacterial pyomyositis in the United States. Am JMed 117(6):420–428
14. Moriarty P, Leung C, Walsh M, Nourse C (2015) Increasingpyomyositis presentations among children in Queensland,Australia. Pediatr Infect Dis J 34(1):1–4
15. Brown JD, Wheeler B (1984) Pyomyositis. Report of 18 cases inHawaii. Arch Intern Med 144(9):1749–1751
16. Verma S, Singhi SC, Marwaha RK, et al. Tropical pyomyositis inchildren: 10 years experience of a tertiary care hospital in northernIndia. J Trop Pediatr. 2013;59(3):243–5.
17. Gambhir IS, Singh DS, Gupta SS, Gupta PR, Kumar M. Tropicalpyomyositis in India: a clinico-histopathological study. J Trop MedHyg. 1992;95(1):42–6.
18. Malhotra P, Singh S, Sud A, et al. Tropical pyomyositis-experienceof a tertiary care hospital in North West India. J Assoc PhysiciansIndia. 2000;48:1057–60.
19. Chauhan S, Kumar R, Singh KK, Chauhan SS. Tropical pyomyositis: adiagnostic dilemma. J Ind Acad Clin Med. 2004;5:52–4.
20. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis(myositis tropicans): current prospective. Postgrad Med J. 2004;80:267–70.
21. Smith MI, Vickers AB. Natural history of 338 treated and untreatedpatients with staphylococcal septicaemia (1936–1955). Lancet.1960;1(7138):1318–22.
22. Jayoussi R, Bialik V, Eyal A, Shehadeh N, Etzioni A. Pyomyositiscaused by vigorous exercise in a boy. Acta Paediatr. 1995;84(2):226–7.
23. Singh SB, Singh VP, Gupta S, Gupta RM, Sunder S. Tropical myo-sitis: a clinical, immunological and histopathological study. J AssocPhysicians India. 1989;37(9):561–3
24. Flier S, Dolgin SE, Saphir RL, et al: A case confirming the progressive stages of pyomyositis, J Pediatr Surg 38:1551, 2003.
25. .Moriarty, Leung C, Walsh M, Nourse C. Increasing pyomyositis presenting among children in Queensland, Australia. PediatrInfect Dis J. 2015;34(1):1–4.
26. Pannaraj PS, Hulten KG, Gonzalez BE, Mason Jr EO, Kaplan SL.Infective pyomyositis and myositis in children in the era of com-munity-acquired, methicillin-resistant Staphylococcus aureus infec-tion. Clin Infect Dis. 2006;43:953–60.
27. Mitchell PD, Hunt DM, Lyall H, Nolam M, et al. Panton-Valentineleukocidin-secreting Staphylococcus aureus causing sever muscu-loskeletal sepsis in children. A new threat. J Bone Joint Surg (Br).2007;89:1239–42.
28. Menge TJ, Cole HA, Mignemi ME, et al. Medial approach fordrainage of the obturator musculature in children.J Pediatr Orthop.2014;34:307–315.
29. Spiegel DA, Meyer JS, Dormans JP, et al. Pyomyositis in childrenand adolescents: report of 12 cases and review of the literature.JPediatr Orthop. 1999;19:143–150.
30. Renwick SE, Ritterbusch JF. Pyomyositis in children.J PediatrOrthop. 1993;13:769–772.
31. Mazur JM, Ross G, Cummings J, et al. Usefulness of magneticresonance imaging for the diagnosis of acute musculoskeletalinfections in children.J Pediatr Orthop. 1995;15:144–147.
32. Peckett WR, Butler-Manuel A, Apthorp LA. Pyomyositis of theiliacus muscle in a child.J Bone Joint Surg Br. 2001;83:103–105.
33. Thomas S, Tytherleigh-Strong G, Dodds R. Pyomyositis of theiliacus muscle in a child.J Bone Joint Surg Br. 2001;83:619–620.
34. Yuh WT, Schreiber AE, Montgomery WJ, et al. Magnetic resonanceimaging of pyomyositis.Skeletal Radiol. 1988;17:190–193.
35. Kocher MS, Zurakowski D, Kasser JR (1999) Differentiating be-tween septic arthritis and transient synovitis of the hip in children:an evidence- based clinical prediction algorithm. J Bone Joint SurgAm 81(12):1662–1670
36. Bertrand SL, Lincoln ED, Prohaska MG. Primary pyomyositis ofthe pelvis in children: a retrospective review of 8 cases.Orthopedics. 2011;34(12):832–40.
37. Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE.Tropical primary pyomyositis in children of the UK: an emerging medical challenge. Int Orthop. 2010;34:109–13.
38. Kiran M, Mohamed S, Newton A, George H, Garg N, Bruce C. Pelvic pyomyositis in children: changing trends in occurrence and management. Int Orthop. 2018 May;42(5):1143-1147.
39. Birkbeck D, Watson JT (1995) Obturator internus pyomyositis. Acase report. Clin Orthop Relat Res 316:221–226
40. Tucker RE, Winter WG, Del Valle C, Uematsu A, Libke R(1978) Pyomyositis mimicking malignant tumor. Three casereports. J Bone Joint Surg Am 60:701–703
41. Karmazyn B, Loder RT, Kleiman MB, et al. The role of pelvicmagnetic resonance in evaluating nonhip sources of infection inchildren with acute nontraumatic hip pain.J Pediatr Orthop.2007;27:158–164.
42. Ovadia D, Ezra E, Ben-Sira L, et al. Primary pyomyositis inchildren: a retrospective analysis of 11 cases.J Pediatr Orthop B.2007;16:153–159.
43. Browne LP, Mason EO, Kaplan SL, et al. Optimal imaging strategyfor community-acquiredStaphylococcus aureusmusculoskeletalinfections in children.Pediatr Radiol. 2008;38:841–847.
44. Karmazyn B, Kleiman MB, Buckwalter K, et al. Acute pyomyositisof the pelvis: the spectrum of clinical presentations and MRfindings.Pediatr Radiol. 2006;36:338–343.
45. Marin C, Sanchez-Alegre ML, Gallego C, et al. Magnetic resonanceimaging of osteoarticular infections in children.Curr Probl DiagnRadiol. 2004;33:43–59.
46. Theodorou SJ, Theodorou DJ, Resnick D. MR imaging findings ofpyogenic bacterial myositis (pyomyositis) in patients with localmuscle trauma: illustrative cases.Emerg Radiol. 2007;14:89–96.
47. Damski GB, Garin EH, Ballinger WE, et al. Generalized non-suppurative myositis with staphylococcal septicemia. J Pediatr.1980;96:694–7.
48. Ameh EA (1999) Pyomyositis in children: analysis of 31 cases.Ann Trop Paediatr 19:263–265
49. Vij N, Ranade AS, Kang P, Belthur MV. Primary Bacterial Pyomyositis in Children: A Systematic Review. J Pediatr Orthop. 2021 Oct 1;41(9):e849-e854.
50. Song J, Letts M, Monson R (2001) Differentiation of psoasmuscle abscess from septic arthritis of the hip in children. ClinOrthop Relat Res 391:258–265
51. Armstrong DG, D’Amato CR, Strong ML (1993) Three cases ofstaphylococcal pyomyositis in adolescence, including one patientwith neurologic compromise. J Pediatr Orthop 13:452–455
52. Teague DC, Graney DO, Routt ML Jr. Retropubic vascular hazardsof the ilioinguinal exposure: a cadaveric and clinical study.J OrthopTrauma. 1996;10:156–159.
53. Karakurt L, Karaca I, Yilmaz E, et al. Corona mortis: incidence andlocation.Arch Orthop Trauma Surg. 2002;122:163–164.
54. Luhmann SJ, Jones A, Schootman M, et al. Differentiation betweenseptic arthritis and transient synovitis of the hip in children withclinical prediction algorithms.J Bone Joint Surg Am. 2004;86-A:956–962.
55. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J. 2004 May;80(943):267-70.
56. White S, Stopka S, Nimityongskul P, Jorgensen D. Transgluteal Approach for Drainage of Obturator Internus Abscess in Pediatric Patients. J Pediatr Orthop. 2017 Jan;37(1):e62-e66.
57. Hall RL, Callaghan JJ, Moloney E, Martinez S, Harrelson JM(1990) Pyomyositis in a temperate climate. Presentation, diag-nosis, and treatment. J Bone Joint Surg Am 72:1240–1244
58. Mignemi ME, Menge TJ, Cole HA, Mencio GA, Martus JE, Lovejoy S, Stutz CM, Schoenecker JG. Epidemiology, diagnosis, and treatment of pericapsular pyomyositis of the hip in children. J Pediatr Orthop. 2014 Apr-May;34(3):316-25.
59. Gupta G, Rabbi Q, Bohra V, Shah MM. Protrusio acetabulae as a sequel to septic arthritis of the hip with obturator internus pyomyositis. J Pediatr Orthop B. 2021 Nov 1;30(6):572-578.
|How to Cite this Article: Desai A, Ranade A, Belthur MV, Patwardhan S, Oka GA | Pelvic Pyomyositis in Children: Current Concepts Review | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 02-07.|