Outline clinical features of third stage pyomyositis?

1. Fever: Patients with third stage pyomyositis may present with a high fever, typically above 101°F.

2. Severe muscle pain: Patients may experience severe pain in the affected muscle, which can be exacerbated by movement or palpation.

3. Swelling and redness: The affected muscle may appear swollen and red, indicating inflammation and infection.

4. Limited range of motion: Patients may have difficulty moving the affected muscle due to pain and swelling.

5. Systemic symptoms: In addition to local symptoms, patients may also experience systemic symptoms such as fatigue, malaise, and chills.

6. Abscess formation: In some cases, third stage pyomyositis can progress to the formation of an abscess within the affected muscle, which may present as a fluctuant mass.

7. Complications: Without prompt treatment, third stage pyomyositis can lead to serious complications such as sepsis, necrotizing fasciitis, and septic arthritis.

Pain and Swelling:

- Diffuse, intense, pulsatile muscle pain
- Significant swelling and tenderness in the affected muscle group

Systemic Symptoms:

- High fever (up to 40°C or higher)
- Chills and sweats
- Malaise and fatigue

Local Signs:

- Erythema and induration of the skin overlying the affected muscle
- Fluctuant abscess formation
- Drainage of pus from the abscess

Other Features:

- Loss of function and impaired range of motion in the affected muscle
- Stiffness and tenderness in the surrounding joints
- Lymphadenopathy in the regional lymph nodes
- Organ involvement in severe cases, such as liver or kidney abscesses

Additional Features in Late Stage Disease:

- Necrosis and muscle destruction
- Septic shock
- Multi-organ failure