Cervical Pyomyositis – A Rare Cause of Cervicalgia Presenting to the Emergency Room

Classically, patients with pyomyositis present with fever, myalgia, and localized tenderness.1 Pyomyositis is most frequently seen in tropical regions, occurs in males aged 20–40 years, and most commonly affects lower limb muscles.1 Pyomyositis can occur in healthy individuals, but often predisposing factors such as immunodeficiency, trauma, injection drug use, concurrent infection, and malnutrition can be identified.2 Pyomyositis is thought to arise via hematogenous spread and leads to multiple abscess formation.3 It can be complicated by local destruction of the vertebrae, septic shock, endocarditis, septic emboli, brain abscess, or rhabdomyolysis.4S. aureus has been implicated in 75–90% of cases.2 Early diagnosis and source control via high-dose antibiotics plus either percutaneous drainage or surgical intervention are necessary to reduce the risk of morbidity.5 The initial misdiagnosis as occipital neuralgia underlines the importance of considering this rare condition in the differential diagnosis of cervicalgia in the emergency setting, even in healthy immunocompetent patients. Acknowledgments The authors wish to acknowledge the contribution of Dr Sebastian Demyttenaere, Department of General Surgery, and Dr Joe Dylewski, Division of Infectious Diseases, St Mary’s Hospital Centre, Montreal, to the clinical care of this patient. Statement of Authorship HG is involved in initial clinical evaluation, literature review, and drafting of the manuscript and revision.