Purulent infectious myositis of deep core muscles, a MRSA infection in India

Purulent Infectious Myositis is a common bacterial infection in peripheral limb muscles, but its involvement in deep core muscles is rare. Staphylococcus aureus is one of the most common organisms causing purulent infectious myositis. With an increase in antibiotic resistance in India, many cases are now being reported caused by Methicillin-resistant Staphylococcus aureus (MRSA). A male farmer in his early 50 s presented with lower back pain, diffuse abdominal pain, significant weight loss, fatigue for one month, and high-grade fever for one week. Clinical examination revealed severe sepsis with tachycardia, hypotension, tachypnoea, and mild diffuse abdominal tenderness. Laboratory investigations demonstrated leucocytosis, elevated inflammatory markers, acute kidney injury, and deranged liver function tests. Imaging studies revealed multiple deep-core muscle abscesses. Ultrasound-guided aspiration yielded pus, and cultures confirmed Methicillin-resistant Staphylococcus aureus. The patient was diagnosed with purulent infectious myositis complicated by severe sepsis, septic shock, acute kidney injury, and sepsis-associated cholestasis. Treatment comprised drainage of abscesses, prolonged antimicrobial therapy and supportive care. The patient had complete resolution of the abscesses on follow-up. This case emphasises the importance of maintaining a high clinical suspicion for purulent infectious myositis—early diagnosis, combined with aggressive medical and surgical management —to achieve early sepsis management and a good prognosis.