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Pyomyositis of extraocular muscle: case series and review of the literature.

Acharya IG, Jethani J - Indian J Ophthalmol (2010 Nov-Dec)

Bottom Line: Three patients were started on intravenous antibiotics immediately on diagnosis and the pus was drained externally.In conclusion, it should be considered in any patient presenting with acute onset of orbital inflammation.Management consists of incision and drainage coupled with antibiotic therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmic Plastic Surgery, Orbit, Ocular Oncology and Ocular Prosthesis, Dr. Thakorbhai V. Patel Eye Institute, Vadodara, Gujarat, India. ishan_ach@rediffmail.com

ABSTRACT
Pyomyositis is a primary acute bacterial infection usually caused by Staphylococcus aureus. Any skeletal muscle can be involved, but the thigh and trunk muscles are commonly affected. Only three cases of extraocular muscle (EOM) pyomyositis have been reported. We herein present four cases of isolated EOM pyomyositis. Three of our cases presented with acute onset of proptosis, pain, swelling and redness. One patient presented with mass in the inferior orbit for 4 months. One patient had central retinal artery occlusion on presentation. None of them had marked systemic symptoms. Computed tomography scan of all patients showed a typical hypodense rim enhancing lesion of the muscle involved. Three patients were started on intravenous antibiotics immediately on diagnosis and the pus was drained externally. Two patients underwent exploratory orbitotomy. In conclusion, it should be considered in any patient presenting with acute onset of orbital inflammation. Management consists of incision and drainage coupled with antibiotic therapy.

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Related in: MedlinePlus

(A) (Top) left eye proptosis and semidilated pupil (middle) showing a well-defined hypodense lesion involving the left lateral rectus with rim enhancement (bottom) and compression of the mid part of the left optic nerve. (B) The uppermost two figures clearly show that the abscess is in the lateral recuts and separate from the subperiosteal plane. Other sections are for comparison
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Figure 0001: (A) (Top) left eye proptosis and semidilated pupil (middle) showing a well-defined hypodense lesion involving the left lateral rectus with rim enhancement (bottom) and compression of the mid part of the left optic nerve. (B) The uppermost two figures clearly show that the abscess is in the lateral recuts and separate from the subperiosteal plane. Other sections are for comparison

Mentions: A 15-year-old boy was referred with complaints of sudden dimness of vision, proptosis, pain and swelling in the left eye (LE) for 5 days in March 2008. On examination, visual acuity in the right eye (RE) was 20/20 and in the LE was 20/200. There was proptosis of 3 mm, edema, ptosis and congestion in the superotemporal quadrant [Fig. 1A]. The pupil was semidilated (6 mm) and relative afferent papillary defect was present. Ocular motility was restricted in the superior, lateral and medial gazes. The posterior segment was normal. Computed tomography (CT) scan showed a well-defined hypodense rim-enhancing lesion involving the left lateral rectus (LR) and abutting the left optic nerve [Fig. 1A and B], with retrobulbar fat infiltration. Blood culture was negative. Differential diagnosis of LR muscle abscess or an infected orbital lesion was performed. An exploratory lateral orbitotomy was performed and pus was drained. He was put on intravenous amikacin 500 mg 12 hourly and cefotaxime 1 g 12 hourly. Vision improved to 20/30 on the very next day and the pupil became normal in size and reaction to light. Gram stain showed positive cocci and the culture report showed growth of Staphylococcus aureus. Ampicillin plus cloxacillin 1 g 12 hourly and amikacin were started according to the sensitivity report. He was discharged with gatifloxacin twice daily orally. After 1 month, he had residual restriction in motility in medial and superior gazes and 1 mm of proptosis. After 1 year, there was no proptosis and motility restriction.


Pyomyositis of extraocular muscle: case series and review of the literature.

Acharya IG, Jethani J - Indian J Ophthalmol (2010 Nov-Dec)

(A) (Top) left eye proptosis and semidilated pupil (middle) showing a well-defined hypodense lesion involving the left lateral rectus with rim enhancement (bottom) and compression of the mid part of the left optic nerve. (B) The uppermost two figures clearly show that the abscess is in the lateral recuts and separate from the subperiosteal plane. Other sections are for comparison
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2993988&req=5

Figure 0001: (A) (Top) left eye proptosis and semidilated pupil (middle) showing a well-defined hypodense lesion involving the left lateral rectus with rim enhancement (bottom) and compression of the mid part of the left optic nerve. (B) The uppermost two figures clearly show that the abscess is in the lateral recuts and separate from the subperiosteal plane. Other sections are for comparison
Mentions: A 15-year-old boy was referred with complaints of sudden dimness of vision, proptosis, pain and swelling in the left eye (LE) for 5 days in March 2008. On examination, visual acuity in the right eye (RE) was 20/20 and in the LE was 20/200. There was proptosis of 3 mm, edema, ptosis and congestion in the superotemporal quadrant [Fig. 1A]. The pupil was semidilated (6 mm) and relative afferent papillary defect was present. Ocular motility was restricted in the superior, lateral and medial gazes. The posterior segment was normal. Computed tomography (CT) scan showed a well-defined hypodense rim-enhancing lesion involving the left lateral rectus (LR) and abutting the left optic nerve [Fig. 1A and B], with retrobulbar fat infiltration. Blood culture was negative. Differential diagnosis of LR muscle abscess or an infected orbital lesion was performed. An exploratory lateral orbitotomy was performed and pus was drained. He was put on intravenous amikacin 500 mg 12 hourly and cefotaxime 1 g 12 hourly. Vision improved to 20/30 on the very next day and the pupil became normal in size and reaction to light. Gram stain showed positive cocci and the culture report showed growth of Staphylococcus aureus. Ampicillin plus cloxacillin 1 g 12 hourly and amikacin were started according to the sensitivity report. He was discharged with gatifloxacin twice daily orally. After 1 month, he had residual restriction in motility in medial and superior gazes and 1 mm of proptosis. After 1 year, there was no proptosis and motility restriction.

Bottom Line: Three patients were started on intravenous antibiotics immediately on diagnosis and the pus was drained externally.In conclusion, it should be considered in any patient presenting with acute onset of orbital inflammation.Management consists of incision and drainage coupled with antibiotic therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmic Plastic Surgery, Orbit, Ocular Oncology and Ocular Prosthesis, Dr. Thakorbhai V. Patel Eye Institute, Vadodara, Gujarat, India. ishan_ach@rediffmail.com

ABSTRACT
Pyomyositis is a primary acute bacterial infection usually caused by Staphylococcus aureus. Any skeletal muscle can be involved, but the thigh and trunk muscles are commonly affected. Only three cases of extraocular muscle (EOM) pyomyositis have been reported. We herein present four cases of isolated EOM pyomyositis. Three of our cases presented with acute onset of proptosis, pain, swelling and redness. One patient presented with mass in the inferior orbit for 4 months. One patient had central retinal artery occlusion on presentation. None of them had marked systemic symptoms. Computed tomography scan of all patients showed a typical hypodense rim enhancing lesion of the muscle involved. Three patients were started on intravenous antibiotics immediately on diagnosis and the pus was drained externally. Two patients underwent exploratory orbitotomy. In conclusion, it should be considered in any patient presenting with acute onset of orbital inflammation. Management consists of incision and drainage coupled with antibiotic therapy.

Show MeSH
Related in: MedlinePlus