A case of missed primary pyomyositis, complicated with compartment syndrome of the left forearm

Abstract

Primary pyomyositis is a rare clinical entity of a subacute and deep bacterial infection of skeletal muscle that is not secondary to a contiguous of the skin, bone, of soft tissues. We describe the case of a one-year-old boy, with no known comorbidities and a missed primary pyomyositis of the left forearm. Due to the delay in diagnosis, no emergency surgical drainage was performed and the child continued to develop full-blown compartment syndrome. Circulation to the left hand was restored through a timely fasciotomy. However, the wound further deteriorated due to inadequate drainage of the abscess, resulting in the necrosis of the flexor muscles with exposed styloid processes of both radius and ulna and with distal radioulnar joint disruption. The wound presented a challenge for us and required a multidisciplinary team approach and multiple surgeries to achieve complete wound closure. Careful attention to medical history, meticulous physical examination, and judicious use of imaging methods are essential in diagnosis; therefore, prompt treatment should be instituted for a favourable evolution of the patient, able thus to prevent possible severe complications.

Keywords

• primary pyomyositis
• compartment syndrome
• fasciotomy
• npwt