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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withdrawn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
"blood cell count"
symptom
alpha-thalassemia
aromatase deficiency
cutaneous mastocytosis
esophageal squamous cell carcinoma
familial mediterranean fever
pyomyositis
systemic capillary leak syndrome
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