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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) proptosis, chemosis and lid edema (B) showing an irregular, ill-defined peripheral rim-enhancing hypodense lesion in the inferior rectus and inferior oblique muscle with soft tissue infiltration of the lid and cheek (C), showing pus pointing in the inferomedial quadrant through the skin (D), showing postincision and drainage clinical picture
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Figure 0004: (A) proptosis, chemosis and lid edema (B) showing an irregular, ill-defined peripheral rim-enhancing hypodense lesion in the inferior rectus and inferior oblique muscle with soft tissue infiltration of the lid and cheek (C), showing pus pointing in the inferomedial quadrant through the skin (D), showing postincision and drainage clinical picture

Mentions: A 55-year-old diabetic female presented to us with complaints of sudden dimness of vision, swelling, pain and redness in the LE of 5 days duration in January 2006. On examination, the pin hole visual acuity in the RE was 20/40 and there was no perception of light in the LE. There was proptosis, edema, ptosis and chemosis. The pupil was dilated and was nonreactive to light. Ocular motility was restricted in all gazes. The posterior segment showed central retinal artery occlusion. CT scan showed an irregular, ill-defined rim-enhancing hypodense lesion in relation to the inferior rectus and inferior oblique muscle with soft tissue infiltration of the lid and cheek [Fig. 4]. Provisional diagnosis of orbital cellulitis was made and ceftriaxone 1 g 12 hourly and amoxicillin plus clavulanate 1.2 g 8 hourly was started intravenously. On the second day of treatment, pus was drained through the skin. Gram stain showed Gram positive cocci and the culture grew Staphylococcus. Her vision did not improve at all. There was hypertropia of the LE and motility was restricted in down gaze at last follow-up after 14 months.


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

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

(A) proptosis, chemosis and lid edema (B) showing an irregular, ill-defined peripheral rim-enhancing hypodense lesion in the inferior rectus and inferior oblique muscle with soft tissue infiltration of the lid and cheek (C), showing pus pointing in the inferomedial quadrant through the skin (D), showing postincision and drainage clinical picture
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: (A) proptosis, chemosis and lid edema (B) showing an irregular, ill-defined peripheral rim-enhancing hypodense lesion in the inferior rectus and inferior oblique muscle with soft tissue infiltration of the lid and cheek (C), showing pus pointing in the inferomedial quadrant through the skin (D), showing postincision and drainage clinical picture
Mentions: A 55-year-old diabetic female presented to us with complaints of sudden dimness of vision, swelling, pain and redness in the LE of 5 days duration in January 2006. On examination, the pin hole visual acuity in the RE was 20/40 and there was no perception of light in the LE. There was proptosis, edema, ptosis and chemosis. The pupil was dilated and was nonreactive to light. Ocular motility was restricted in all gazes. The posterior segment showed central retinal artery occlusion. CT scan showed an irregular, ill-defined rim-enhancing hypodense lesion in relation to the inferior rectus and inferior oblique muscle with soft tissue infiltration of the lid and cheek [Fig. 4]. Provisional diagnosis of orbital cellulitis was made and ceftriaxone 1 g 12 hourly and amoxicillin plus clavulanate 1.2 g 8 hourly was started intravenously. On the second day of treatment, pus was drained through the skin. Gram stain showed Gram positive cocci and the culture grew Staphylococcus. Her vision did not improve at all. There was hypertropia of the LE and motility was restricted in down gaze at last follow-up after 14 months.

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