Why does my wife have a swelling around her left clavicular area?

Question

Hello doctor,

My 37-year-old wife was infected with some virus a month ago. She ran a fever of around 100 to 102°F for four days. She was treated for the flu, so the fever went away on the fifth day, but she had a very noticeable swelling around the left clavicular area. Her blood work showed normal WBC, but with a differential lymphocytes of 7.4 %. She was sent for a CT scan of the chest, where the swelling was, which showed possible injury or trauma. She had not been injured or struck, but she did have a chair massage the day before her fever started. After the CT scan, she had a chest MRI with contrast, and the area showed chest muscle infection and no indication of swollen lymph nodes. Since then, she has had no fever; however, she has very limited mobility in her left arm, making it difficult even to dress. The swelling is still there, and you can see it spasm or tighten upon performing any activity with the left arm. What is this? She currently takes Topamax, Prednisone, and Bactrim medicines.

Kindly guide.

Answer 1

Hello,

Welcome to icliniq.com.

From your description, it appears to be a pyomyositis, a bacterial infection of muscle, probably of the pectoral muscle. It is usually seen in immunosuppressed patients. You mentioned she is receiving Prednisone, it could be due to this. What is the reason for taking Prednisone?

Trauma to muscle is a predisposing factor, although a definitive history of trauma is present only in 20 to 30 % patients, in the rest it happens without being noticed.

I would request you to upload the CT and MRI reports so that I can understand them better. Her lymphocyte percentage is low, and probably her neutrophils must be high, which is suggestive of bacterial infection. She should also check her procalcitonin level, which will provide additional evidence of bacterial infection.

If there is clear pus collection, it should be drained. If not, then a biopsy of the muscle should be taken to identify the bacteria and give antibiotics according to the sensitivity.

Usually, it is caused by MRSA (Methicillin-resistant Staphylococcus aureus), so try doing the following.

Try taking antibiotics like Teicoplanin or Vancomycin.
Continue arm movement; otherwise, it will get stiff.
She can do hot water fomentation.
Try applying Diclofenac gel or spray.
Try taking tablet Ibuprofen 400 or Naproxen 250 mg, whenever needed, up to two to three times a day.
An antacid-like tablet, Pantoprazole, before breakfast should be taken along with the painkiller.
Prednisone should be tapered off after discussion with your doctor.

So, consult your specialist doctor, discuss with him or her, and start taking the medicines after their consent.

I hope this helps.

Thank you.