Case Report

The piriformis abscess: a case-based review

Abstract

This study reports a 43 years-old man diagnosed with piriformis pyomyositis. A literature review was conducted by searching MEDLINE via Pubmed for English language case reports, published from 8th December 2019 to 20th January 2020. Patients' symptoms, laboratory tests, imaging, treatment, and other comorbidities were evaluated. Thirty-two cases diagnosed with piriformis pyomyositis, of which 21 patients developed piriformis abscess (including one new patient added by us) of which 52.4% were female, and the mean age was 26.98 ± 17.5. The most common manifestations were fever, lower back pain, and limited ambulation with increased ESR, CRP, or leukocytosis. Staphylococcus aureus was the most prevalent (57.14%) pathogen isolated. The authors suggested gynecologic manipulations, muscle overuse, and other co-infections as probable risk factors. However, we fail to find any association between these factors and abscess formation (p>0.05). Piriformis abscess should be regarded as a probable diagnosis in patients with gluteal pain, fever, and limited ambulation that have raised inflammatory markers or leukocytosis. MRI and CT scans are beneficial in diagnosing pyomyositis in early-stage. Full recovery is expected with timely antibiotic and surgical treatments.

1. Bickels J, Ben-Sira L, Kessler A, Wientroub S. Primary pyomyositis. J Bone Joint Surg Am 2002;84:2277-2286.
2. Chiedozi LC. Pyomyositis: Review of 205 cases in 112 patients. Am J Surg 1979;137:255-259.
3. Berkelhammer C, Debre M, Gutti PJIbd. Piriformis muscle abscess complicating Crohn's ileitis. Inflamm Bowel Dis 2005;11:1028-1029.
4. Nitta AT, Kuritzkes DR. Pyomyositis due to group C streptococci in a patient with AIDS. Rev Infect Dis 1991;13:1254-1255.
5. Siddiq MAB, Rasker JJ. Piriformis pyomyositis, a cause of piriformis syndrome—a systematic search and review. Clin Rheumatol 2019; 38:1811-1821.
6. Elhagar A, Kamar I, Elsheikh MF, Mahapatra A, Ahmed TF, Acharya Y, et al. Unusual case of lower back pain-piriformis myositis: a case report and literature review. Pan Afr Med J 2019;32:4.
7. Hu MT, Shaw CE, Evans S, Britton TC. Acute sciatica with an infective cause. J R Soc Med 1998;91:87-88.
8. Phadke PS, Gandhi AR, More SA, Joshirao RP. Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case. J Postgrad Med 2017;63:44-46.
9. Scott S, Carlan SJ, Busowski M, Wilson J, Madruga M. Invasive fusobacterium necrophorum disease in a patient with postpartum bacteremia and muscle abscess. IDCP 2015;23(4):e26-27.
10. Wong LF, Mullers S, McGuinness E, Meaney J, O’Connell MP, Fitzpatrick C. Piriformis pyomyositis, an unusual presentation of leg pain post partum–case report and review of literature. J Matern Fetal Neonatal Med 2012;25:1505-1507.
11. Chusid MJ, Hill WC, Bevan JA, Sty JR. Proteus pyomyositis of the piriformis muscle in a swimmer. Clin Infect Dis 1998;26:194-195.
12. Burkhart BG, Hamson KR. Pyomyositis in a 69-year-old tennis player. Am J Orthop (Belle Mead NJ) 2003;32(11):562-563.
13. Giebaly DE, Horriat S, Sinha A, Mangaleshkar S. Pyomyositis of the piriformis muscle presenting with sciatica in a teenage rugby player. BMJ Case Rep 2012;2012:bcr1220115392.
14. Toda T, Koda M, Rokkaku T, Watanabe H, Nakajima A, Yamada T, et al. Sciatica caused by pyomyositis of the piriformis muscle in a pediatric patient. Orthopedics 2013;36(2):e257-259.
15. Chong K, Tay B. Piriformis pyomyositis: A rare cause of sciatica. Singapore Med J 2004;45:229-231.
16. Colmegna I, Justiniano M, Espinoza L, Gimenez C. Piriformis pyomyositis with sciatica. J Clin Rheumatol 2007;13:87-88.
17. Ruiz ME, Yohannes S, Wladyka CG. Pyomyositis caused by methicillin-resistant Staphylococcus aureus. N Engl J Med 2005;352:1488-1489.
Files
IssueVol 13 No 2 (2021) QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/ijm.v13i2.5988
Keywords
Bacterial infection; Abscess; Staphylococcal infections; Piriformis muscle syndrome; Pelvic pain
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Salehi M, Ghiasvand F, Feizabadi MM, Zarei M, Ayoobi Yazdi N, Alijani N, Qaempanah M, Seyedpour S. The piriformis abscess: a case-based review. Iran J Microbiol. 2021;13(2):252-256.