case_images: PMC6444765_01
case_images: Presenting history and timeline of symptomatology prior to admission.
case_images: 10.1177_2050313X19840243-fig1.jpg
case_images: PMC6444765_01_10.1177_2050313X19840243-fig1.jpg
case_images: fig1-2050313X19840243
case_images: He later developed severe ipsilateral back and buttock pain, not amenable to 1650 mg of naproxen and 50 mg of tramadol given over 12 h before he presented to the ED as he had difficulty with ambulation (see Figure 1).
case_images: Magnetic resonance imaging (MRI) of the lumbosacral spine showing the erector spinae
  pyomyositis abscess complex. T2W images in the (a) sagittal and (b) axial planes at
  L5/S1 and (c) S2 show hyperintense signal in the left erector spinae muscle extending
  from L4 to S3 with small central area of post contrast peripheral rim enhancement
  representing the abscess (yellow arrows). T1W images in the (d) sagittal and (e) coronal
  views demonstrate similar features. Fat suppressed STIR imaging reveals entire extent of
  pyomyositis involving the erector spinae (f, red arrows).
case_images: 10.1177_2050313X19840243-fig2.jpg
case_images: PMC6444765_01_10.1177_2050313X19840243-fig2.jpg
case_images: fig2-2050313X19840243
case_images: A magnetic resonance imaging (MRI) scan of the back done on 12 September 2017 showed myositis of the left erector spinae muscle from L5 to S3 with an associated small central linear rim enhancing area suspicious of an abscess (see Figure 2).
case_images: Inpatient clinical and biochemical markers trend during admission.
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case_images: fig3-2050313X19840243
case_images: He was continued instead on IV antibiotics until discharge on 21 September 2017 following evidence of down trending temperature and inflammatory markers (see Figure 3).