PYOMYOSITIS

Introduction

Background
Pyomyositis is an inflammation of muscle tissue, usually of voluntary muscles that
results in pus production. Once considered a tropical disease, it is now seen in temperate
climates as well. The pathogenesis is unclear, but trauma, infections (S. aureus, S. pneumoniae),
and malnutrition have been implicated. Although most cases of pyomyositis occur in healthy
individuals, other pathogenetic factors include nutritional deficiency and associated parasitic
infection in tropical climates. In the temperate climates, pyomyositis is seen most commonly in
patients with diabetes, HIV infection, and malignancy.

Clinical Presentations

 Presentation with painful, tender, localized swelling over muscle 

 Fever
 Epidural abscess

Complications

 Life-threatening complications include sepsis and toxic shock syndrome.

Diagnosis

 CT scan or MRI demonstrates muscle abscess.

 Aspiration of abscess (by surgery or CT/US guided) yields pus, usually yielding S. aureus.
 Bacteremia may accompany.

Treatment

Medical Care

 Promptly administer systemic antibiotics. This could eliminate the need for surgical
drainage in selected cases.
 The choice of antibiotic is determined by identification of the causative organism.
 Antibiotics initially are given intravenously until clinical improvement is noted, followed
by oral antibiotics for a total course of 3 weeks (eg, cefazolin or ceftriaxone IV followed
by cephalexin PO).

Surgical Care
  During the suppurative phase, abscess aspiration under ultrasonic or CT guidance may
be required. Surgical drainage is especially necessary for large abscesses.
 Complicated cases may require fasciotomies and debridement.

Prognosis

 Prompt administration of antibiotics can result in complete resolution.

Specific Objectives:

 Define Pyomyositis.
 Identify the signs and symptoms manifested by the patient.
 Distinguish the precipitating and predisposing factors that trigger this development.
 Trace the pathogenesis based on the signs and symptoms manifested by the patient.
 Determine appropriate medical and nursing management for the patient.
 Use the nursing process as the framework for the care of the patient.

Significance of the Study in Nursing Field:

 Shall have critical thinking skills necessary for providing safe and effective nursing care.
 Shall have a comprehensive assessment and implement care base on our knowledge
and skills of the condition.
 Shall have familiarized with effective interpersonal skills to emphasize health promotion
and illness prevention.
 Shall have imparted the learning experience from direct patient care.
 PATIENT’S PROFILE
Name: Bagra
Sex: Female
Birthday: October 2007
Age: 2 - 3 y/o
Religion: Roman Catholic
Civil Status: Single
Nationality: Filipino
Date of Admission: 9/2/10
Time of Admission: 3:15 PM
Admission Diagnosis: Pyomyositis Left Scapular Area
Attending Physician: Dr. Kwak Kwak

A. Family Background
Baby Bagra is the youngest among the four siblings.

B. Educational and Socio - Economic Status

She does not go to school yet. The rest of the siblings are funded for their educational
expenses by one of their mother’s rich customers as a laundry woman, except that the eldest
child does not go to school anymore as she decided to stop studying and just help work.

C. Lifestyle and Diet

She eats three times a day and drinks 5-6 glasses of water a day though mostly
breastfeed on her mother.

D. Family Health History

No family history of pyomyositis, diabetes, hypertension, tuberculosis, diabetes, nor any
other diseases reported.

E. Immunization Record
With complete record of immunization.

F. Past Health History

Had cough, colds and fever but is only hospitalized once – now due to pyomyositis.
G. Present Health History
One month prior to consultation, patient together with her older brother had a fall as
she was given a piggy backride. Patient fell on her left scapular area and complained of pain.
Her mother had her massaged by a so-called manghihilot. Three weeks prior to consultation,
patient still complained of pain and endured of fever and localized swelling on the left scapular
area. Another hilot session was done and patient was given TSB. But as the swelling and fever
still persevered, patient was brought to the nearest clinic. Patient was given Paracetamol and
was referred to Philippine Orthopedic Center. Patient was admitted.
 ANATOMY AND PHYSIOLOGY

The scapula or shoulder blade is the bone that

connects the humerus (arm bone) with the clavicle (collar
bone). The scapula forms the posterior located part of
the shoulder girdle. It is a flat bone, roughly triangular in
shape, placed on a posterolateral aspect of the thoracic
cage.

LEFT SCAPULA . LATERAL SURFACE

 CORACOID PROCESS - bony projection on the shoulder

blade
 GLENOID CAVITY– holds the head of the humerus
 SUPRAGLENOID TUBERCLE – rounded protuberance
above the glenoid cavity
 INFRAGLENOID TUBERCLE – rounded protuberance
below the glenoid cavity
 SPINE – a bony projection from the glenoid to acromion
 ACROMION - bony projection from the outer end of the
spine of the shoulder blade, to which the collar bone is
attached
 AXILLARY BORDER – near to armpit
 INFERIOR ANGLE - gives greater strength to the body of
the bone by its arched form

OSSIFICATION OF SCAPULA

The larger part of the scapula undergoes membranous

ossification. Some of the outer parts of the scapula are
cartilagenous at birth, and would therefore undergo
endochondral ossification.
The head, processes, and the thickened parts of the bone, contain cancellous tissue; the
rest consists of a thin layer of compact tissue.
The central part of the supraspinatous fossa and the upper part of the infraspinatous
fossa, but especially the former, are usually so thin as to be semitransparent; occasionally the
bone is found wanting in this situation, and the adjacent muscles are separated only by fibrous
tissue.
 PATHOGENESIS

Fell on her left scapular Area from a Piggy Backride

Inflammatory Response Trauma: Pressure by hilot

Vascular Response Chemical Response Systemic Response

Vasodilatation Redness Pain Leukocytosis Infiltration

Heat PR and RR

Increased Membrane Permeability Swelling Increased ESR

Fever

Abscess Formation

PYOMYOSITIS

IF NOT TREATED: IF TREATED:

Toxic Shock Syndrome Sepsis Good Prognosis
Recovery
Diagnostic Exam

MUSCULOSKELETAL SONOGRAPHY

There is a 5.0 x 1.2 cm complex mass in the left scapular area. Remainder is
unremarkable.

Impression: PYOMYOSITIS
 DISCHARGE SUMMARY

M edications. Compliance on the prescribed take home medications with the right generic
name, right dosage and preparation, right route and time of administration.

E xercise. Active ROM but prevent massaging nor any other traumatic pressure on the
affected area.

T reatment. Compliance on the prescribed treatment. Cover the affected area with a
wound gauze as pt has underwent surgery. Instructed proper wound care.

H ealth teachings. Emphasized proper handwashing and encouraged non pharmacological

measures for fracture once re encountered (Rest, Ice or Cold Compress, Compression
bandage, Elevate affected part)

O utpatient follow up visit. Attend on the scheduled outpatient follow up visit.

D iet. Consume foods rich in Vitamin C such as fruits for boosting of immunity, protein
such as meats for tissue repair, and calcium or phosphorus such as milk and other dairy
products for bone growth.
 Case study
Pyomyositis

Submitted to: Mrs. Jessica Corpuz

Submitted by: Balanay, Randolf Mark P.

BSN-IV A/Group B-2/Wcc-Antipolo

 Case study
Osteomyelitis

Submitted to: Mrs. Jessica Corpuz

Submitted by: Padernal Joel,jr D

BSN-IV A/Group B-2/Wcc-Antipolo