Community-Acquired MRSA Pyomyositis: Case Report and Review of the Literature

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal. 1. Introduction The differential diagnosis of fever and back pain in an intravenous drug abuser is broad. Pyomyositis is an intramuscular abscess of the large skeletal muscle groups with most initial cases in the tropics but with increasing worldwide distribution in nontropical areas as well. It is often not diagnosed until the later stages of infection [1]. Diagnosis is based on a combination of clinical, laboratory, and radiologic findings [1, 2]. Once treatment is begun, outcome generally correlates with the extent of disease. We present a case of primary pyomyositis with osteomyelitis that, despite appropriate antibiotics and drainage, progressed and extended into the epidural space, compressing the entire spinal column. The objectives of this paper are to: (1) present a case of progressive pyomyositis and (2) review the diagnosis and treatment of an infection that has been increasing in incidence in tropical and temperate climates. 2. Case A 46-year-old gentleman presented to the hospital complaining of right paraspinal back pain of 2-month duration with increasing intensity. In the days prior to admission, he had also noticed fevers, decreased appetite and overall malaise. The patient had a medical history of uncomplicated, untreated genotype 1 hepatitis C virus (HCV) and dyspepsia. Surgical history was unremarkable. He was not taking any medications. He lived at home with his mother. His last reported IV drug use was two months prior. He continued to smoke a pack of cigarettes a day and denied alcohol use. He was heterosexual and denied unsafe sexual practices. There was no recent travel and