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Rare disease
CASE REPORT
Subscapularis pyomyositis: a rare presentation of shoulder pain
  1. Simond Jagernauth1,
  2. Reece Alexander James Clough2,
  3. Ali Noorani1,
  4. Muaaze Ahmad3
  1. 1Orthopaedic Department, Royal London Hospital, London, UK
  2. 2Barts and The London School of Medicine and Dentistry, London, UK
  3. 3Radiology Department, Royal London Hospital, London, UK
  1. Correspondence to Reece Alexander James Clough, ha15303{at}qmul.ac.uk

Summary

We present a rare case of a subscapularis pyomyositis in a 38-year-old woman and examine the diagnostic and surgical challenges posed. History and examination features were similar to that of septic shoulder arthritis without overlying features of warmth or erythema. Serological markers revealed a C-reactive protein of 221 mg/L and white cell count of 11.1×109/L. A dry shoulder aspirate was obtained. Contrast-enhanced MRI demonstrated a peripheral rim-enhancing lesion within the subscapularis muscle belly with lack of central enhancement. These features are consistently seen with an infective aetiology. A deltopectoral approach to surgical drainage was utilised and subsequent fluid cultures grew Panton–Valentine Leukocidin positive Staphylococcus aureus species. This rare bacterium is associated with an increased risk of osteomyelitis and despite making a full recovery, the patient was advised to reattend if any future shoulder pain was encountered.

  • orthopaedics
  • orthopaedic and trauma surgery
  • bone and joint infections

https://doi.org/10.1136/bcr-2017-223982

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    Footnotes

    • Contributors SJ and RAJC drafted the work, MA was involved in the image selection and interpretation and AN was involved in the concept and revision of manuscript. All the authors contributed equally to the production of the manuscript. All the authors have met the ICMJE recommendations for authorship and confirm there is no one else who fulfils the criteria that has been excluded as an author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.