Radiological Identification and Review of Lumbosacral Paraspinal Muscle Pyomyositis and Abscesses in a Young Male With Streptococcus Bacteremia: A Case Report

TL;DR

A young man with a rare muscle infection caused by Streptococcus bacteria was diagnosed using MRI and successfully treated with antibiotics.

Contribution

This case report highlights the use of MRI in diagnosing pyomyositis caused by a rare Streptococcus species.

Findings

MRI revealed ring-enhancing lesions in multiple paraspinal muscles consistent with pyomyositis.

The patient was successfully treated with ceftriaxone and cefadroxil, showing clinical improvement.

Streptococcus parasanguinis was identified as the causative agent, a rare cause of pyomyositis.

Abstract

We present a case report of a 21-year-old male patient with lumbosacral pyomyositis and abscesses secondary to Streptococcus parasanguinis, along with a review of the literature. The patient was admitted with acute metabolic encephalopathy, rhabdomyolysis secondary to cannabinoid use, acute kidney injury, and right lower extremity weakness. T2-weighted magnetic resonance imaging (MRI) of the lumbar region demonstrated multiple ring-enhancing nodular lesions within the left multifidus muscles, left erector spinae muscle, and left quadratus lumborum muscle. He was successfully treated with ceftriaxone and discharged on cefadroxil with improved right lower extremity strength. This case highlights MRI as an integral modality for the detection and treatment guidance of pyomyositis, providing a relevant microbiological-radiological association for rare causes of pyomyositis, such as Streptococcus parasanguinis.

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