PRIMARY
HAEMOPHILUS INFLUENZAE PYOMYOSITIS IN AN INFANT: A CASE REPORT
Seçmeer G,
Toyran M, Kara A, Isik P, Kanra G, Ceyhan M, Cengiz AB, Ali H
Dept. of
Pediatric Infectious Disease, Hacettepe University School of Medicine,
Ankara, Turkey
Pyomyositis is a term used to denote primary pyogenic infection of
the skeletal muscle. Because striped muscle tissue is normally resistant to
bacterýal infection, pyomyositis is very rare. It is predominantly a
disease of tropical countries, and hence is also referred to as tropical
pyomyositis or myositis tropicans. On the other hand, there were also
reports from Europe, America, Japan and other non-tropical countries.
Because the occurrence of the pyomyositis is very rare especially in
infancy, and also diagnosis of it can be difficult in the view of indolent
presentation. We would like to present a 8 month infant to make,
pediatrician aware of possibility of pyomyositis in case of a mass over
muscle, or children complaining of joint pain or muscle aches even in infancy
period. Eight months old, previously healthy, well-developed boy presented
with a mass at his right calf. The child did not have fever or any other
symptoms before or during this period. On physical examination a hard mass
was palpated on the gastrocinemius muscle with little redness and hotness
on it. White blood cell count 17000/mm3, sedimentation rate was 60mm\hour,
alkaline phosphates, creatine phosphokinase, and the other laboratory
parameters were within normal limits. Plain roentgenogram was also normal.
Ultrasonographic examination of the region revealed a hypoecoic lesion of
2xl cm diameter in the gastrocinemius muscle that was considered to be a
fluid collection around which there was hyperecogenity. Abscess formation
and pyomyositis was suspected and the patient was hospitalised. The region
was surgically debrided on the same day. Microscopic examination ofthe
material revealed many polymorphonuclear leucocytes, but no microorganism
was seen on gram stain. Biopsy from drainage site showed acute inflammation
without any specific findings. Intravenous sulbactam
ampiciline was started at a dose of 100 mg\kg in four
doses. The culture of the purulent material yielded Haemophilus. influenza
type b and it was susceptible to sulbactam ampiciline. The patient was
hospitalised for 10 days for parenteral antibiotic therapy and the
treatment was continued orally for another 4 days. He was completely
recovered.