Chandra Atanu, Ray Aritra Kumar, Hati Arkapravo, Chakraborty Uddalak
Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India.
BMJ Case Rep. 2021 May 6;14(5):e242565. doi: 10.1136/bcr-2021-242565.
Tropical pyomyositis manifests as single or multiple abscesses inside skeletal muscles and it has a higher prevalence in immunocompromised patients. Scrub typhus, a zoonotic disease is caused by and the clinical manifestations range from simple febrile illness to organ threatening complications. Here, we present a rare case of an immunocompetent young man diagnosed as tropical pyomyositis in association with scrub typhus. Imaging of both thighs revealed multiple intramuscular abscesses. Blood and aspirated pus were culture negative. Patient was treated aggressively with parenteral antibiotics (linezolid, clindamycin and meropenem) and surgical debridement. But, fever did not subside and total leucocyte count remained persistently high. After serological confirmation of scrub typhus, the patient was put on oral doxycycline and he had a dramatic improvement within next few days. To the best of our knowledge, this is probably the first reported case of tropical pyomyositis in association with scrub typhus.
热带脓性肌炎表现为骨骼肌内的单个或多个脓肿，在免疫功能低下的患者中发病率较高。恙虫病是一种人畜共患病，由……引起，临床表现从单纯发热性疾病到威胁器官的并发症不等。在此，我们报告一例罕见病例，一名免疫功能正常的年轻男性被诊断为热带脓性肌炎合并恙虫病。双大腿影像学检查显示多个肌内脓肿。血液和吸出的脓液培养均为阴性。患者接受了肠外抗生素（利奈唑胺、克林霉素和美罗培南）积极治疗及手术清创。但是，发热未消退，白细胞总数持续居高不下。恙虫病血清学确诊后，患者开始口服多西环素，在接下来的几天内病情有显著改善。据我们所知，这可能是首例热带脓性肌炎合并恙虫病的报告病例。
