Pyomyositis in children and adolescents: Report of 12 cases and review of the literature

Pyomyositis initially was observed more commonly in the developing world bu t now is reported with increasing frequency in the United States. The prese ntation is nonspecific and the differential diagnoses are many. We found th e clinical history, laboratory findings, and response to treatment similar to those observed in different areas of the world. Magnetic resonance imagi ng (MRI) with gadolinium injection, in addition to helping to make the diag nosis, may help differentiate between early and late stages that help guide treatment. Coexisting bone changes (58%) may represent either the sensitiv ity of MRI to reactive inflammatory changes or the presence of a coexisting osteomyelitis. All patients responded to antibiotics and drainage if absce sses were present. Although the optimal duration of antibiotic therapy rema ins unclear, a shorter course should be considered in patients with a good clinical response, even when MRI shows nonspecific bony abnormalities. Perc utaneous drainage was successful in five cases and may represent an alterna tive to the traditional surgical approach.