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Primary multifocal pyomyositis due to Staphylococcus aureus.

A 20-year-old man was referred to our institution with complaints of a 2-week prodrome of myalgia, rigors, drenching sweats and general malaise. There was no history of recent trauma, viral illness, extreme exercise or intravenous drug use. He had no other comorbidities. His only contact with doctors was a year prior to this presentation, when he had a gunshot to his back, with the bullet fragment still lodged in his thoracic spine. Clinically, he was pyrexial with a temperature of 39.8°C. His pulse was 124 beats per minute, with a blood pressure of 130/70 mmHg. His muscles were diffusely swollen, with fluctuance and exquisite tenderness particularly over his pelvic girdle, the shoulders and back, and his forearms. In these areas, the overlying skin was oedematous, erythematous and warm, with the underlying muscles having a firm, wooden texture (Figure 1). 



Figure 1. 
Pictures of the patient showing: ( A ) a swollen, erythematous forearm with …