title: Tuberculous pyomyositis: a re-emerging entity of many faces.
abstract: Tuberculosis (TB) has become a global concern due to its increasing incidence, particularly in immunocompromised patients, closely following the migratory patterns of populations. TB pyomyositis is a rare extrapulmonary manifestation of TB. Its clinical presentation varies and requires a high degree of suspicion for early diagnosis. We present three patients diagnosed with TB pyomyositis: a 46-year-old man with dermatomyositis (DM) and hepatitis B who presented with fever, muscle weakness, and an abscess at the right proximal arm; a 71-year-old immunocompetent male, with a past medical history of tuberculous lymphadenopathy in childhood, who presented with a 2-month history of fever and pain at the right thigh, and a 44-year-old woman with systemic lupus erythematosus (SLE) on prednisone and methotrexate who presented with skin eruption at her thighs mimicking lupus panniculitis. In all three patients, Mycobacterium tuberculosis was identified as the causative agent. The lack of specific signs, the false negative tuberculin skin test in some cases, and the unfamiliarity of many clinicians with this entity can cause diagnostic delays. Prompt diagnosis requires a high index of suspicion especially in immunocompromised patients with fever.
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Simopoulou
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Areti
authors.initials: A
authors.lastname: Varna
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Dailiana
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Katsiari
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Alexiou
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Basdekis
authors.affiliation: Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.|Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Malizos
authors.affiliation: Department of Orthropaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, 41 110, Greece. lsakkas@med.uth.gr.
authors.forename: Lazaros I
authors.initials: LI
authors.lastname: Sakkas
mesh_terms: D000038:Abscess / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003882:Dermatomyositis / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology*; D009169:Mycobacterium tuberculosis; D052880:Pyomyositis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology
keywords: Muscle abscess; Mycobacterium; Pyomyositis; Tuberculosis