Streptococcus pyogenes (Group A) can cause a pyomyositis. Often there is no direct portal of entry identified, so the source is presumably hematogenous.
Clinical and laboratory features:
(1) infection is localized to a skeletal muscle with severe pain, swelling, and fever
(2) elevated serum CK
(3) positive Gram stain and/or muscle culture for Streptococcus pyogenes
Complications:
(1) deep vein thrombosis
(2) sepsis
(3) muscle compartment syndrome
Differential diagnosis:
(1) streptococcal toxic shock syndrome with rhabdomyolysis
(2) streptococcal necrotizing fasciitis
(3) other forms of bacterial pyomyositis
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