Limits...
Pyomyositis at the surgical site in a patient with chronic myeloid leukemia: a case report and literature review.

Takebayashi K, Sonoda H, Shimizu T, Ohta H, Minamiguchi H, Ishida M, Mekata E, Endo Y, Tani T, Tani M - World J Surg Oncol (2016)

Bottom Line: Two months after the second surgery, imatinib therapy was reinitiated; however, he again developed painful swelling and erythema in his right thigh.A CT scan revealed a similar shadow as described previously.The case report is followed by a discussion of the literature regarding this disease, including potential risk factors and the underlying pathogenesis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.

ABSTRACT

Background: Pyomyositis is a rare, subacute, deep pyogenic infection of the muscle tissue. This disease has been previously described in patients that were immunocompromised due to a hematological malignancy.

Case presentation: A 68-year-old man with a history of chronic myeloid leukemia was treated with imatinib. He was diagnosed with ascending colon cancer and underwent curative surgery. His postoperative course was uneventful, and he was healthy at 6 months after surgery, allowing for reinitiation of imatinib therapy. After the reinitiation of therapy, a computed tomography (CT) scan revealed a mass shadow in the right iliopsoas muscle. This lesion was clinically diagnosed as recurrent colon cancer with an abscess, which was resected surgically. A pathological examination uncovered both edema and inflammation. Two months after the second surgery, imatinib therapy was reinitiated; however, he again developed painful swelling and erythema in his right thigh. A CT scan revealed a similar shadow as described previously. He was then diagnosed with pyomyositis; he underwent incisional drainage and was administered linezolid. Following the treatment for pyomyositis, there was no cancer recurrence or evidence of any recurrent pyomyositis.

Conclusions: Findings from this case suggest that both undergoing surgery and receiving imatinib therapy may modulate an individual's immune response, whereby the surgical site becomes more prone to infection and may predispose an individual to pyomyositis. The case report is followed by a discussion of the literature regarding this disease, including potential risk factors and the underlying pathogenesis.

No MeSH data available.


Related in: MedlinePlus

A computed tomography scan reveals a retroperitoneal abscess close to the ileocolostomy. The retroperitoneal abscess and fistula extends from the psoas abscess to the femoral abscess (encircled by the dotted line)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4837566&req=5

Fig1: A computed tomography scan reveals a retroperitoneal abscess close to the ileocolostomy. The retroperitoneal abscess and fistula extends from the psoas abscess to the femoral abscess (encircled by the dotted line)

Mentions: A 68-year-old man was diagnosed with CML in 2009. His complete blood cell count at the initial diagnosis was as follows: a white blood cell (WBC) count of 24,500 cells/μL, neutrophil bands of 64 %, hemoglobin level of 10 g/dL, platelet count of 537,000 cells/μL, and a lactate dehydrogenase (LDH) level of 346 IU/L. He has been treated with 300 mg of imatinib once a day. After 6 months, a complete cytogenetic response was achieved and the 300-mg imatinib therapy with was continued. In April 2010, he was diagnosed with T2N0M0, stage I ascending colon cancer, and underwent curative surgery with regional lymph node dissection without adjuvant chemotherapy. His postoperative course was uneventful, and he was healthy at 6 months after surgery, allowing for reinitiation of the imatinib therapy (300 mg/day). In November 2010, a computed tomography (CT) scan revealed a mass shadow in the right iliopsoas muscle that was contiguous with the site of the ileocolostomy (Fig. 1). His body temperature was 37.2 °C, and the results of his routine laboratory examination were as follows: WBC count of 9700 cells/μL, C-reactive protein (CRP) level of 16.7 mg/dL, and LDH and creatine kinase (CK) levels within the normal range. A CT-guided biopsy and total colonoscopy did not demonstrate the presence of malignant cells, and no bacteria were isolated from the drained fluid culture. After 6 months, a CT scan revealed that the mass shadow had enlarged. This lesion was clinically diagnosed as recurrent colon cancer with an abscess, which was then resected surgically. A pathological examination uncovered both edema and inflammation of the fascia and muscular tissues with the presence of lymphocytes, neutrophils, plasma cells, and foreign-body giant cells. The pathological diagnosis was granulation tissue with no malignancy (Fig. 2a, b). The patient’s postoperative course was good, and he was healthy without recurrence at 2 months after the second surgery, allowing for reinitiation of imatinib therapy (300 mg/day). However, he developed painful swelling and erythema on the right thigh after reinitiating therapy. His body temperature was 37.4 °C, and the results of his routine laboratory examination were as follows: WBC count of 7100 cells/μL, CRP level of 1.93 mg/dL, and LDH and CK levels within normal range. A CT scan revealed a mass shadow extending from the right iliopsoas muscle to the right thigh muscle 2 months after the surgery for retroperitoneal granulation and abscess (Fig. 3a–c). A femoral muscle biopsy showed no malignancy. No bacteria were isolated from the blood and drained fluid cultures. Despite the administration of several antibiotics, the patient improved after starting an oral linezolid therapy and undergoing incisional femoral muscle drainage. The routine laboratory examination results were within normal range with values as follows: a WBC count of 4500 cells/μL, CRP level of 0.2 mg/dL, and LDH and CK levels within normal range. After that, he no longer received oral imatinib therapy. There was no cancer recurrence or evidence of any recurrent pyomyositis 2 years after his recovery from final pyomyositis occurrence.Fig. 1


Pyomyositis at the surgical site in a patient with chronic myeloid leukemia: a case report and literature review.

Takebayashi K, Sonoda H, Shimizu T, Ohta H, Minamiguchi H, Ishida M, Mekata E, Endo Y, Tani T, Tani M - World J Surg Oncol (2016)

A computed tomography scan reveals a retroperitoneal abscess close to the ileocolostomy. The retroperitoneal abscess and fistula extends from the psoas abscess to the femoral abscess (encircled by the dotted line)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837566&req=5

Fig1: A computed tomography scan reveals a retroperitoneal abscess close to the ileocolostomy. The retroperitoneal abscess and fistula extends from the psoas abscess to the femoral abscess (encircled by the dotted line)
Mentions: A 68-year-old man was diagnosed with CML in 2009. His complete blood cell count at the initial diagnosis was as follows: a white blood cell (WBC) count of 24,500 cells/μL, neutrophil bands of 64 %, hemoglobin level of 10 g/dL, platelet count of 537,000 cells/μL, and a lactate dehydrogenase (LDH) level of 346 IU/L. He has been treated with 300 mg of imatinib once a day. After 6 months, a complete cytogenetic response was achieved and the 300-mg imatinib therapy with was continued. In April 2010, he was diagnosed with T2N0M0, stage I ascending colon cancer, and underwent curative surgery with regional lymph node dissection without adjuvant chemotherapy. His postoperative course was uneventful, and he was healthy at 6 months after surgery, allowing for reinitiation of the imatinib therapy (300 mg/day). In November 2010, a computed tomography (CT) scan revealed a mass shadow in the right iliopsoas muscle that was contiguous with the site of the ileocolostomy (Fig. 1). His body temperature was 37.2 °C, and the results of his routine laboratory examination were as follows: WBC count of 9700 cells/μL, C-reactive protein (CRP) level of 16.7 mg/dL, and LDH and creatine kinase (CK) levels within the normal range. A CT-guided biopsy and total colonoscopy did not demonstrate the presence of malignant cells, and no bacteria were isolated from the drained fluid culture. After 6 months, a CT scan revealed that the mass shadow had enlarged. This lesion was clinically diagnosed as recurrent colon cancer with an abscess, which was then resected surgically. A pathological examination uncovered both edema and inflammation of the fascia and muscular tissues with the presence of lymphocytes, neutrophils, plasma cells, and foreign-body giant cells. The pathological diagnosis was granulation tissue with no malignancy (Fig. 2a, b). The patient’s postoperative course was good, and he was healthy without recurrence at 2 months after the second surgery, allowing for reinitiation of imatinib therapy (300 mg/day). However, he developed painful swelling and erythema on the right thigh after reinitiating therapy. His body temperature was 37.4 °C, and the results of his routine laboratory examination were as follows: WBC count of 7100 cells/μL, CRP level of 1.93 mg/dL, and LDH and CK levels within normal range. A CT scan revealed a mass shadow extending from the right iliopsoas muscle to the right thigh muscle 2 months after the surgery for retroperitoneal granulation and abscess (Fig. 3a–c). A femoral muscle biopsy showed no malignancy. No bacteria were isolated from the blood and drained fluid cultures. Despite the administration of several antibiotics, the patient improved after starting an oral linezolid therapy and undergoing incisional femoral muscle drainage. The routine laboratory examination results were within normal range with values as follows: a WBC count of 4500 cells/μL, CRP level of 0.2 mg/dL, and LDH and CK levels within normal range. After that, he no longer received oral imatinib therapy. There was no cancer recurrence or evidence of any recurrent pyomyositis 2 years after his recovery from final pyomyositis occurrence.Fig. 1

Bottom Line: Two months after the second surgery, imatinib therapy was reinitiated; however, he again developed painful swelling and erythema in his right thigh.A CT scan revealed a similar shadow as described previously.The case report is followed by a discussion of the literature regarding this disease, including potential risk factors and the underlying pathogenesis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.

ABSTRACT

Background: Pyomyositis is a rare, subacute, deep pyogenic infection of the muscle tissue. This disease has been previously described in patients that were immunocompromised due to a hematological malignancy.

Case presentation: A 68-year-old man with a history of chronic myeloid leukemia was treated with imatinib. He was diagnosed with ascending colon cancer and underwent curative surgery. His postoperative course was uneventful, and he was healthy at 6 months after surgery, allowing for reinitiation of imatinib therapy. After the reinitiation of therapy, a computed tomography (CT) scan revealed a mass shadow in the right iliopsoas muscle. This lesion was clinically diagnosed as recurrent colon cancer with an abscess, which was resected surgically. A pathological examination uncovered both edema and inflammation. Two months after the second surgery, imatinib therapy was reinitiated; however, he again developed painful swelling and erythema in his right thigh. A CT scan revealed a similar shadow as described previously. He was then diagnosed with pyomyositis; he underwent incisional drainage and was administered linezolid. Following the treatment for pyomyositis, there was no cancer recurrence or evidence of any recurrent pyomyositis.

Conclusions: Findings from this case suggest that both undergoing surgery and receiving imatinib therapy may modulate an individual's immune response, whereby the surgical site becomes more prone to infection and may predispose an individual to pyomyositis. The case report is followed by a discussion of the literature regarding this disease, including potential risk factors and the underlying pathogenesis.

No MeSH data available.


Related in: MedlinePlus