Jpn. J. Infect. Dis., 58 (6), 376-379, 2005
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Short Communication
A Case of Tuberculous Pyomyositis That Caused a Recurrent Soft Tissue Lesion Localized at the Forearm
Orhan Baylan*, Bahtiyar Demiralp1, Engin Ilker Cicek1, Ali Albay, Mahmut Komurcu1, Ozgul Kisa, Armagan Gunal2, and Mehmet Sahin Ugurel3
Department of Microbiology and Clinical Microbiology, 1Department of Orthopedics and Traumatology, 2Department of Pathology and 3Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey
(Received July 21, 2005. Accepted September 30, 2005)
*Corresponding author: Mailing address: Department of Microbiology and Clinical Microbiology, Gulhane Military Medica Academy School of Medicine, 06018, Etlik, Ankara, Turkey. Tel: +90-312-304-3438, Fax: +90-312-304-3402, E-mail: obaylan@gata.edu.tr
SUMMARY: We present the case of a 20-year-old male who had a non-traumatic soft tissue lesion (4 x 3 cm) with recurrent discharge at his right posteromedial antebrachial muscles; the patient underwent surgery twice, and antibiotic therapy was administered, but no cure was achieved with these treatments. The patient underwent surgery at our medical center. There was no history of pulmonary, gastrointestinal, or genitourinary tuberculosis (TB). Due to suspected pulmonary, genitourinary, and gastrointestinal TB, radiography and computed tomography scans were performed, and these studies disclosed no evidence of a primary origin. The erythrocyte sedimentation rate and the results of purified protein derivate testing were normal. We also detected submandibular lymphadenopathy (LAP) (2 x 3 cm) localized at a submandibular site in our patient 4 months after his first visit to our clinic. Smears were stained with Ehrlich Ziehl Neelsen (EZN) stain and culture were grown for Mycobacterium tuberculosis complex (MTC); the samples used for these assays had been obtained by incisional biopsy of the forearm lesion and by aspiration of the submandibular lymph node, and they were found to be MTC-positive. Then, a culture for MTC, derived from an induced sputum sample, was found to be positive, despite the negative results obtained with a sputum smear subjected to EZN staining. According to these results, the primary focus of the tuberculous pyomyositis and the submandibular LAP was the lungs. The lesion and submandibular LAP were both treated successfully by the administration of antituberculous chemotherapy.