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Tuberculous pyomyositis: a rare but serious diagnosis.
[pyomyositis]
Tuberculous
pyomyositis
is
a
rare
clinical
entity
with
serious
consequences
if
a
diagnosis
is
not
established
early
.
A
53
-
year
-old
female
with
a
past
medical
history
of
sarcoidosis
and
pulmonary
fibrosis
presented
from
an
outside
hospital
with
persistent
fevers
and
a
rash
.
She
had
been
hospitalized
multiple
times
at
an
outside
hospital
without
any
improvement
in
her
symptoms
.
On
examination
,
she
was
noted
to
have
a
large
area
of
left
upper
lower
extremity
(
LUE
)
tenderness
with
superimposed
erythema
.
Laboratory
data
revealed
a
white
blood
cell
count
of
22
,
300
.
Computed
tomography
(
CT
)
scans
of
the
LUE
,
chest
,
and
left
lower
extremity
(
LLE
)
showed
multiple
intramuscular
abscesses
in
those
regions
without
evidence
of
osteomyelitis
.
Subsequent
drainage
of
the
abscesses
and
resulting
cultures
revealed
Mycobacterium
tuberculosis
.
The
patient
was
started
on
therapy
with
rifampin
,
isoniazid
,
pyrazinamide
,
and
ethambutol
.
However
,
the
patient
developed
hepatitis
on
these
agents
and
subsequently
went
into
septic
shock
with
multiorgan
failure
.
Care
was
eventually
withdrawn
as
a
result
of
a
poor
prognosis
.
This
case
illustrates
the
severe
consequences
of
TB
pyomyositis
if
not
diagnosed
promptly
.
While
tuberculosis
is
uncommon
in
the
United
States
,
it
should
be
an
important
consideration
in
the
differential
diagnosis
of
immunocompromised
patients
.
Diseases
Validation
Diseases presenting
"erythema"
symptom
acute rheumatic fever
cowden syndrome
cutaneous mastocytosis
epidermolysis bullosa simplex
erythropoietic protoporphyria
familial mediterranean fever
harlequin ichthyosis
inclusion body myositis
kindler syndrome
lamellar ichthyosis
legionellosis
liposarcoma
malignant atrophic papulosis
neuralgic amyotrophy
omenn syndrome
pyomyositis
thoracic outlet syndrome
This symptom has already been validated