Navinan Mitrakrishnan Rayno, Yudhisdran Jevon, Kandeepan Thambyaiah, Kulatunga Aruna
National Hospital of Sri Lanka, Regent Street, Colombo, 10, Sri Lanka.
J Med Case Rep. 2015 Feb 15;9:39. doi: 10.1186/s13256-015-0513-z.
Pyomyositis, though classically considered a tropical disease, has a variable geographic prevalence. Among the predisposing risk factors, immunodeficiency plays an important role. Pyomyositis has a tendency to mimic more commonly considered diseases, and a lack of familiarity with it is a cause of delayed diagnosis.
A 53-year-old South Asian man with newly diagnosed type 2 diabetes mellitus was referred to our medical unit in an advanced stage of the disease, which was complicated by sepsis and acute kidney injury. Failure of the referring unit to provide prompt treatment, as well as their delay in coming to a diagnosis, led to the patient's complicated state. Antibiotic therapy was initiated, and clinical stabilization was achieved with supportive measures. Following the patient's recovery from sepsis, his persistent leukopenia and anemia was suggestive of an underlying immunodeficiency, and a subsequent bone marrow biopsy revealed acute myeloid leukemia, M2 variant. Multi-disciplinary care was initiated by the medical, surgical and oncological teams.
Awareness of tropical pyomyositis is lacking. Common predisposing behaviors and conditions should always be sought and investigated. Immunosuppressive state is an important predisposing factor in the pathogenesis of pyomyositis. Early antibiotic treatment is pivotal in management, and surgical intervention, when relevant, should not be delayed. Identifying one cause should not halt the search for others, as pyomyositis may herald underlying sinister diseases.
脓性肌炎虽传统上被视为热带疾病，但其地理分布患病率各异。在诱发风险因素中，免疫缺陷起着重要作用。脓性肌炎往往会模仿更常见的疾病，对其缺乏了解是导致诊断延迟的原因。
一名53岁新诊断为2型糖尿病的南亚男性在疾病晚期被转诊至我们的医疗单位，该疾病并发脓毒症和急性肾损伤。转诊单位未能及时治疗以及诊断延误导致患者病情复杂。开始使用抗生素治疗，并通过支持措施实现了临床稳定。患者从脓毒症中康复后，其持续的白细胞减少和贫血提示存在潜在的免疫缺陷，随后的骨髓活检显示为急性髓系白血病M2型变异。医疗、外科和肿瘤学团队启动了多学科护理。
对热带脓性肌炎缺乏认识。应始终寻找并调查常见的诱发行为和状况。免疫抑制状态是脓性肌炎发病机制中的重要诱发因素。早期抗生素治疗在管理中至关重要，相关时手术干预不应延迟。确定一个病因不应停止寻找其他病因，因为脓性肌炎可能预示着潜在的严重疾病。
