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Primary Pyomyositis of the Paravertebral Muscles Involving the Adjacent Facet Joint: The Diagnostic Yield of Positron Emission Tomography-Computed Tomography: A Case Report.

Primary pyomyositis is a rare subacute bacterial infection that can affect any muscle group in the body. Usually, a single muscle is involved. Primary pyomyositis of the paraspinal muscles has been described in several case reports1-4. In a review of 676 patients with pyomyositis, 3.8% had involvement of the paraspinal muscles5.

Pyomyositis progresses from diffuse inflammation to focal abscess in three distinct consecutive stages5-7. During the first invasive stage, inflammation of a muscle, sealed within its aponeurosis, leads to a dull cramping pain and general malaise. Patients are usually afebrile, although some have a low-grade fever. In these cases, there is no abscess that requires drainage2,5. The second suppurative stage is usually characterized by local and systemic manifestations of infection. Imaging studies generally demonstrate an abscess. The third stage is characterized by signs and symptoms of septic shock. Staphylococcus aureus infection was responsible for 70% to 95% of cases in which bacteria were identified in previous case reports2,5. The characteristic magnetic resonance imaging (MRI) findings include muscle swelling and enlargement, with an increase in signal intensity on T2-weighted images, with or without intramuscular abscesses5,6,8. Sometimes, however, diagnosing pyomyositis solely on the basis of MRI findings may be difficult7,9. The aim of this case report is to describe the use of 18-fluorodeoxyglucose (18-FDG) positron emission tomography-computed tomography (PET-CT) for the diagnosis of paraspinal pyomyositis in a young woman. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.

A previously healthy twenty-five-year-old woman presented to our emergency department with incapacitating and worsening backache, without radiation of pain to the lower extremities, for three days. She …