Primary pyomyositis of the sternocleidomastoid muscle: A case report and review of the literature

Abstract

Pyomyositis is a bacterial infection of the striated muscle that may affect the cervical musculature in very few cases. In the occidental world it has been associated with chro- nic diseases as diabetes and immunosuppression. We present a 67 year old patient attended to the Emergency Department because of a laterocervical fast growth tumor, without an interesting clinical history with the exception of type II diabetes mellitus. A CT scan with contrast showed an increased volume in the left sternocleidomastoid muscle, so an empiric treatment with intravenous antibiotics was started. Because of a bad evolution we finally performed a surgical drainage of the abscess under general anesthesia with an improvement of symptoms and laboratory markers. The pyomyosi- tis of cervical muscles is very rare (0.4-1% of all cases) and the sternocleidomastoid muscle is the most commonly affected cervical muscle. CT scan is the gold standard imaging technique, because it allows to diagnose this disease and rule out other similar entities. If we consider that many patients present with associated comorbidities and/ or immunosuppression, it’s very important to perform a rapid diagnosis and to begin a correct treatment that depends on the grade and extension of the infection. Although polymyositis of the sternocleidomastoid muscle is rare, its incidence is increasing as- sociated to HIV infection and other immunosuppressive conditions. We have to keep in mind this pathology in the differential diagnosis of laterocervical tumors because high clinical suspicion is necessary to make a rapid diagnosis and a correct treatment.