Pyopericarditis and tropical pyomyositis: unusual concomitance

The authors report a case of a 19-year-old male who presented to the emergency room complaining of chest pain. His physical examination was unremarkable, but the EKG showed PR deviation and ST segment elevation. The patient was diagnosed as probable viral pericarditis and was prescribed oral anti-inflammatories. After 3 days he returned, complaining of chest pain worsening, generalized muscle pain and fever. Laboratory examinations showed creatine kinase isoenzyme MB (CK-MB) = 89.5 ng.mL(–1) and C-Reactive Protein (CRP) = 391 mg.L(–1). Echocardiogram showed pericardial thickening but no pericardial effusion was present. During admission the patient evolved with cardiac tamponade. Empirical ceftriaxone and oxacillin were started and the patient underwent pericardial surgical drainage. Staphylococcus aureus was isolated from the pericardial effusion. After 7 days the patient started complaining of leg pain, and fever recurred. Computed tomography of the lower limbs identified large muscle commitment compatible with the presence abscesses. These findings were suggestive of staphylococcal tropical myositis. The patient was treated with abscesses drainage and oxacillin. He was discharged after 18 days to complete oral antibiotic therapy.