Treatment: Antibiotics, drainage
Choose an antibiotic empirically that covers S aureus and is also appropriate for MRSA. Pyomyositis discovered in the first stage may resolve with antibiotics alone.4 In addition, early intervention may be especially important with MRSA, since MRSA bacteremia is associated with increased mortality compared with methicillin-sensitive S aureus bacteremia.6
If the condition progresses to the second stage with abscess development, surgical or percutaneous drainage will be necessary. Identification and removal of the site of infection in patients with community-acquired staphylococcal bacteremia results in improved outcomes,8 and pyomyositis can be an overlooked source.
Patient outcome
The day following drainage of the abscess, the patient was discharged from the hospital. He was treated for 6 weeks with intravenous antibiotics because of staphylococcal bacteremia, and he has fully recovered.
Acknowledgments
The authors would like to thank Robert Martin, Lead Operator, Information Technology, Texas Tech University Health Sciences Center at Amarillo for assistance in computer image enhancement and development.
CORRESPONDENCE
Timothy J. Benton, MD, Texas Tech University Health Sciences Center at Amarillo, Department of Family and Community Medicine, 1600 Wallace Boulevard, Amarillo, TX 79106. E-mail: timothy.benton@ttuhsc.edu