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Drugs, muscle pallor, and pyomyositis.
[pyomyositis]
A
33
-
year
-old
athletic
male
was
unexpectedly
found
dead
in
his
bed
.
For
several
days
prior
to
his
death
he
complained
of
tenderness
and
swelling
of
his
right
buttock
.
The
post-mortem
examination
revealed
unilateral
pale
gluteal
muscles
and
pustular
impetiginized
skin
lesions
of
the
right
lower
leg
.
The
muscle
histology
demonstrated
pronounced
acute
inflammation
and
limited
necrosis
of
muscle
fibers
confined
to
the
right
gluteal
muscles
.
Vascular
occlusion
and
renal
abnormalities
were
excluded
by
post-mortem
angiography
and
histology
respectively
,
and
the
diagnosis
of
non-
tropical
pyomyositis
,
possibly
originating
from
the
dermatological
infection
,
was
made
.
Toxicological
testing
revealed
a
potentially
lethal
intoxication
with
fentanyl
and
morphine
.
Pyomyositis
is
etiologically
attributed
to
an
infection
and
predominantly
affects
large
limb
or
trunk
muscles
.
Males
are
affected
more
frequently
than
females
.
Histologically
,
it
is
dominated
by
acute
inflammatory
infiltrates
and
may
lead
to
sepsis
and
subsequent
death
.
Although
occurring
less
frequently
,
pyomyositis
must
be
considered
in
the
differential
diagnosis
of
macroscopic
localized
muscle
pallor
,
together
with
vascular
occlusion
and
rhabdomyolysis
.
In
such
cases
,
only
the
examination
of
fresh
frozen
muscle
tissue
samples
from
different
locations
,
together
with
the
histological
examination
of
the
internal
organs
,
particularly
the
kidneys
,
will
facilitate
the
confirmation
of
the
correct
diagnosis
.
Diseases
Validation
Diseases presenting
"pronounced acute inflammation and limited necrosis of muscle"
symptom
pyomyositis
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