Abad Jamie Therese, Gandikota Sreenavya, Chehimi Allen, Bunch Connor, Jomaa Diana
Internal Medicine, Henry Ford Health System, Detroit, USA.
Internal Medicine, Wayne State University School of Medicine, Detroit, USA.
Cureus. 2025 Jun 22;17(6):e86545. doi: 10.7759/cureus.86545. eCollection 2025 Jun.
Infectious myositis is a rare but serious condition typically caused by bacterial pathogens. In immunocompromised patients, including those on long-term immunosuppressive therapy, clinical signs of myositis can be subtle or delayed. We present the case of a 21-year-old woman with systemic lupus erythematosus (SLE) on immunosuppressive therapy who presented with pain, fever, tachycardia, and swelling of the right lower leg. Initial evaluation revealed no skin defects or rash and normal creatine phosphokinase (CPK) levels. A non-contrast computed tomography (CT) scan of her leg showed some soft tissue changes, but it was only after a week of worsening symptoms that contrast-enhanced CT imaging revealed a multiloculated, large abscess, measuring 23.7 cm in length, in the anterior compartment of the leg. The abscess was drained surgically, and intraoperative cultures grew methicillin-resistant . The absence of early definitive findings, including a normal CPK level, may have contributed to the delay in diagnosis. This case highlights the diagnostic challenges of infectious myositis in immunosuppressed patients, where early imaging and laboratory findings can be misleading, underscoring the importance of repeated clinical assessment and timely advanced imaging to ensure early detection and appropriate treatment.
感染性肌炎是一种罕见但严重的疾病，通常由细菌病原体引起。在免疫功能低下的患者中，包括那些接受长期免疫抑制治疗的患者，肌炎的临床症状可能不明显或出现延迟。我们报告了一例21岁患有系统性红斑狼疮（SLE）且正在接受免疫抑制治疗的女性病例，她出现了疼痛、发热、心动过速以及右小腿肿胀的症状。初步评估未发现皮肤缺损或皮疹，肌酸磷酸激酶（CPK）水平正常。她腿部的非增强计算机断层扫描（CT）显示有一些软组织变化，但直到症状恶化一周后，增强CT成像才显示在小腿前侧有一个多房性的大脓肿，长23.7厘米。脓肿通过手术引流，术中培养出耐甲氧西林……早期明确诊断结果的缺失，包括CPK水平正常，可能导致了诊断延迟。该病例凸显了免疫抑制患者感染性肌炎的诊断挑战，即早期影像学和实验室检查结果可能具有误导性，强调了反复进行临床评估和及时进行高级影像学检查以确保早期发现和适当治疗的重要性。
