Dhital Rashmi, Basnet Sijan, Poudel Dilli Ram
Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
University of Pennsylvania, Philadelphia, PA 19104, USA.
Medicina (Kaunas). 2019 Jan 17;55(1):19. doi: 10.3390/medicina55010019.
: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context. : A 40-year-old male with diabetes presented with exquisite pain and weakness of proximal extremities. He denied trauma, recent travel, new medications, or substance use. He denied prior rheumatologic, thyroid, or musculoskeletal disorders. The urine culture revealed staphylococcal infection with negative blood cultures. Rheumatologic and endocrine workups were negative. Random muscle biopsy was negative for inflammatory infiltrate. MRI of thighs and arms showed innumerable foci of nodular and ring enhancement in the proximal muscle groups. The patient noted improvement after about 10 days of antibiotics with complete resolution at 2 months. : Bacterial myositis is most often due to (70%) and affects a single muscle. Multifocal abscesses are rare and strongly suggest transient bacteremia. Our patient most likely had transient initiating staphylococcal bacteremia leading to diffuse myositis and hematogenous urinary tract infection (UTI). A delay in treatment can be life-threatening.
急性近端肌无力的鉴别诊断范围广泛。感染性肌炎在临床上很难与炎性肌病区分开来，常导致诊断延迟。在合适的情况下，应将感染性肌炎视为近端肌肉疼痛和无力的鉴别诊断之一。：一名40岁的糖尿病男性患者出现四肢近端剧痛和无力。他否认有外伤、近期旅行、新用药或药物使用史。他否认既往有风湿性、甲状腺或肌肉骨骼疾病。尿培养显示葡萄球菌感染，血培养阴性。风湿和内分泌检查均为阴性。随机肌肉活检未见炎性浸润。大腿和手臂的MRI显示近端肌群有无数结节状和环形强化灶。患者在使用抗生素约10天后症状改善，2个月时完全缓解。：细菌性肌炎最常见的原因是（70%），且累及单一肌肉。多灶性脓肿罕见，强烈提示短暂菌血症。我们的患者很可能有短暂的葡萄球菌菌血症，导致弥漫性肌炎和血源性尿路感染（UTI）。治疗延迟可能危及生命。
