Pyomyositis of the Extraocular Muscles
Authors: David Plemel, Michael Ashenhurst.
Author Disclosure Block: D. Plemel: None. M. Ashenhurst: None.
Purpose: The purpose of this study was to describe a case of spontaneous pyomyositis of an extraocular muscle and describe the reported management strategies.
Study Design: Case report and literature review.
Methods: A Pubmed review with reference searching was used to identify published cases of extraocular muscle pyomyositis.
Results: The authors describe a 39-year-old otherwise healthy male presenting with a spontaneous pyomyositis of the superior rectus muscle. The patient was successfully treated with intravenous antibiotics alone. A Pubmed review with reference searching identified thirteen additional cases of extraocular muscle pyomyositis. The most common presenting findings were periocular edema (11/14; 78.5%), extraocular muscle limitation (11/14; 78.5%), decreased vision (9/14; 64.3%) and proptosis (7/14; 50%). Seven of ten (70%) patients who had their lesion cultured grew Staphylococcus species while the other three showed no growth. No bacteremia was detected in any of the seven patients who had blood cultures drawn. All cases of pyomyositis resolved with treatment, and only three (3/14; 21.4%) had residual scarring causing ocular motility limitations. Eleven (11/14; 78.6%) underwent surgical drainage while three, including this case, resolved with antibiotics alone.
Conclusions: Most cases of extraocular muscle pyomyositis are due to Staphyloccocus. Prompt targeted antibiotic therapy alone may be adequate treatment, but those resistant to treatment should be considered for surgical drainage with culture.