Diagnosis and management of acute pyomyositis associated with bacterial endocarditis: case report
DOI:
https://doi.org/10.56294/saludcyt2023436Keywords:
Pyomyositis, Endocarditis Bacterial, Venous Thrombosis, Abscess, CelluliteAbstract
Background: Pyomyositis associated with bacterial endocarditis constitute clinical entities with significant repercussions on the patient's health status. They represent infectious emergencies whose microorganism involved is Staphylococcus Aureus in more than half of the cases.
Case Report: a 59-year-old male patient, with a history of type 2 diabetes mellitus, was admitted due to a clinical picture compatible with cellulitis and deep vein thrombosis in the left lower limb. Magnetic resonance imaging was performed, evidencing the presence of a collection (abscess) at the level of the gastrocnemius muscle and bacteremia due to methicillin-sensitive Staphylococcus Aureus. An echocardiogram was performed with the presence of vegetations on the aortic heart valve.
Evolution: during the hospital stay, the patient remained hemodynamically stable with torpid evolution of the lesion in the left leg due to microorganism resistance to the antibiotics initially established (cefazolin and clindamycin). Targeted antibiotic treatment is performed based on the results of the blood culture and abscess culture based on oxacillin, which shows significant improvement in the lesion and the patient's health status. A new control echocardiogram was performed with a decrease in the diameter of the vegetation on the heart valve. Medical discharge was decided after the results of the control blood culture with a report of absence of bacterial growth, with continuation of antibiotic therapy for 4 more weeks.
Conclusions: Pyomyositis and bacterial endocarditis are pathologies that require multidisciplinary management due to their high risk of morbidity and mortality. Individualizing each case can be decisive in safeguarding the patient's life and ensuring an adequate full recovery of his health
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