Recurrent bilateral pyomyositis secondary to septic embolism due to culture-negative endocarditis

Abstract

Pyomyositis is a purulent infection of the skeletal muscle that arises from hematogenous spread, usually with abscess formation. It is a classic of the tropics, although it has been recognized in temperate climates with increasing frequency. Typically, it begins with pain and mild swelling of the involved muscles, which become increasingly tender and indurated. Staphylococcus aureus is the most common cause of pyomyositis; it causes up to 90% of tropical cases and up to 75% of all other cases. Infective endocarditis (IE) refers to infection of the endocardial surface of the heart. The three most common causes of IE worldwide are staphylococci, streptococci, and enterococci. However, in some cases, identifying the responsible microorganism represents a challenge for the treating physician. Blood culture-negative IE is defined as endocarditis without etiology after inoculating at least three independent blood samples into a standard culture-negative blood culture system after seven days of incubation and subculture. In this report, the clinical case of a 47-year-old patient with recurrent bilateral pyomyositis secondary to septic embolism due to culture-negative endocarditis is reported, and an extensive review of the literature is carried out. Pyomyositis represents a poorly understood condition that requires a significant level of suspicion, especially in patients with some form of immunocompromise