A Unique Case of Spontaneous Pectoral Abscess

Authors

Martin Sentmanat, HCA HealthcareFollow
Zachary Shields, HCA HealthcareFollow
David Ross, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Emergency Medicine

Document Type

Poster

Publication Date

2024

Keywords

abscess, chest pain

Disciplines

Bacterial Infections and Mycoses | Emergency Medicine | Medicine and Health Sciences | Musculoskeletal Diseases

Abstract

Pyomyositis is a rare disease that is often misdiagnosed. Formerly more common in tropic areas, it has been more prevalent in temperate climates in the past couple of decades. Most cases of pyomyositis have a known cause or the patient is immunocompromised, but there are a few documented cases of spontaneous pyomyositis in an otherwise healthy patient. Our case describes a 35-year-old male with no past medical history or history of IV drug use who presented to the emergency department with right sided chest pain. The patient was initially seen and diagnosed with a pectoral muscle strain and fever. He returned several days later with the same symptoms and was ultimately found to have a pectoralis major abscess accompanied by elevated inflammatory and cardiac biomarkers. A subsequent IR drainage of the fluid collection revealed gram-positive cocci in pairs concerning for streptococcus species. There are several case reports of spontaneous pyomyositis in otherwise healthy patients. Some cases with group A strep presume a hematogenous spread from strep pharyngitis. Other reports posit small abrasions as a possible source of pyomyositis from normal skin flora such as staph aureus or epidermidis. However, there is no other documented case in the literature of spontaneous pyomyositis of any location in an immunocompetent adult with an elevated troponin. Given that the troponin elevation resolved after drainage of the pyomyositis, this points to a likely demand ischemia rather than a separate cardiac etiology. Our case reveals that pyomyositis can mask itself as an injury of cardiac etiology, especially given the location of the patient’s pain, such as myocarditis or pericarditis in addition to the usual misdiagnoses of muscle strain or other use injuries. In this way, our case can serve as an example for future clinicians to look for a zebra during their diagnostic workup for chest pain.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Sentmanat, Martin; Shields, Zachary; and Ross, David, "A Unique Case of Spontaneous Pectoral Abscess" (2024). North Texas GME Research Forum 2024. 46.
https://scholarlycommons.hcahealthcare.com/northtexas2024/46