Pyomyositis complicating the acquired immunodeficiency syndrome. A report of two cases with coexistent neutropenia.

OBJECTIVE

To identify some factors contributing to the development of pyomyositis in patients with the acquired immunodeficiency syndrome (AIDS) by a report of two cases and a review of the literature.

CLINICAL FEATURES: A 36-year-old man with AIDS presented with tenderness of the left adductor longus muscle; a 28-year-old man with AIDS presented with fever and left leg pain. Both men had a history of severe neutropenia induced by drug treatment and opportunistic infections requiring treatment in hospital. The pyomyositis was defined by a gallium-67 scan (and, in one case, by a computed tomography scan). In one case Staphylococcus aureus was cultured from blood; in the other it was cultured from pus from the pyomyositic abscess.

INTERVENTIONS: Both patients had their abscesses drained. The first patient was treated with flucloxacillin (2 g every four hours, given intravenously) and rifampicin (450 mg by mouth each day). The second patient was treated with flucloxacillin (2 g every four hours, given intravenously) and ticarcillin (3 g every six hours, given intravenously).

OUTCOME: After their symptoms abated, both patients were discharged from hospital, taking flucloxacillin by mouth as ongoing treatment.

CONCLUSIONS

Staphylococcal infections are increasingly common in neutropenic patients. Neutropenia is likely to have contributed to the development of pyomyositis in these patients.