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Kidney Week

Abstract: PO2206

Bilateral Pyomyositis in a Kidney Transplant Patient

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Ilkun, Olesya, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, United States
  • Raghavan, Divya, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, United States
  • Shihab, Fuad S., University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, United States
Introduction

Immunocompromised hosts are susceptible to infectious complications including pyomyositis, a purulent bacterial infection of deep skeletal muscle that most commonly affects lower extremities (LE) and is acquired through hematogenous spread, trauma or injections.

Case Description

A 30-year-old man who received a kidney transplant in 2015 for ESRD due to congenital obstructive uropathy presented to an outside hospital with dysuria, bilateral LE pain, leukocytosis to 18.9 k/uL, and an elevated serum creatinine of 4.7 mg/dL. He was treated with intravenous (IV) antibiotics and his dysuria resolved but bilateral LE pain persisted and he was unable to ambulate. He denied recent vigorous exercise, trauma to his calves or history of IV drug use. Leukocytosis persisted at 20.2 k/uL and he had elevated CRP at 7.5 mg/dL. Ultrasound showed no venous thrombi but was notable for avascular fluid collections in the bilateral medial calves. MRI showed a 2.1 x 3.6 x 7.1 cm fluid collection centered in the gastrocnemius with marked muscle edema, and a similar fluid collection in the contralateral LE at the same location (Figure 1). On further questioning, the patient admitted that two months prior he injected B12, that he had purchased online, into his bilateral calves. Incisions and drainage yielded turbid-looking fluid. Bacterial and fungal cultures showed no growth. Acid-fast stain was negative. The patient's antimicrobial treatment was broadened and he rapidly improved leaving the hospital shortly thereafter.

Discussion

This is a rare case of bilateral pyomyositis in a kidney transplant patient. The inability to culture an organism is likely due to preceding IV antibiotic treatment. This case underscores the importance of keeping a broad differential diagnosis and obtaining a detailed history when treating immunosuppressed patients.

Figure 1