Falasca G F, Reginato A J
Department of Medicine, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden, NJ.
J Rheumatol. 1994 Oct;21(10):1932-7.
(1) To describe the clinical and radiographic features of 6 patients with myositis or rhabdomyolysis associated with bacterial infection. (2) To analyze the role of computed tomography (CT) in myositis associated with bacterial infection.
Review of cases treated by the authors with literature review.
Two patients had classical pyomyositis with Staphylococcus aureus as the etiologic agent. One patient had pyomyositis with Enterobacter cloacae (the first reported to our knowledge), 2 had myositis/fasciitis (one due to Clostridium perfringens and one due to S. aureus), and one had fatal toxic rhabdomyolysis in association with C. perfringens bacteremia without evidence of gas gangrene. No patient had a completely normal CT scan of affected muscles, but CT scans in 3 patients failed to show abscesses that were subsequently discovered at surgery, while in another patient CT scanning falsely suggested a large abscess that was not present at surgery.
Infection associated muscle involvement represents a spectrum of clinical manifestations that include pyomyositis, myonecrosis, fasciitis/myositis, and toxic rhabdomyolysis. Diagnosis may be delayed by the often mild clinical presentation. CT scanning alone may be unreliable in distinguishing muscle abscess from swollen muscle unless combined with CT guided needle biopsy.
（1）描述6例与细菌感染相关的肌炎或横纹肌溶解症患者的临床和影像学特征。（2）分析计算机断层扫描（CT）在与细菌感染相关的肌炎中的作用。
回顾作者治疗的病例并进行文献复习。
2例患者患有以金黄色葡萄球菌为病原体的典型脓性肌炎。1例患者患有阴沟肠杆菌引起的脓性肌炎（据我们所知首次报道），2例患有肌炎/筋膜炎（1例由产气荚膜梭菌引起，1例由金黄色葡萄球菌引起），1例因产气荚膜梭菌菌血症出现致命性中毒性横纹肌溶解症，无气性坏疽证据。没有患者受影响肌肉的CT扫描完全正常，但3例患者的CT扫描未显示随后手术中发现的脓肿，而另1例患者的CT扫描错误地提示存在一个手术中未发现的大脓肿。
感染相关的肌肉受累表现为一系列临床表现，包括脓性肌炎、肌坏死、筋膜炎/肌炎和中毒性横纹肌溶解症。由于临床表现通常较轻，诊断可能会延迟。除非结合CT引导下针吸活检，仅CT扫描在区分肌肉脓肿和肿胀肌肉方面可能不可靠。
