Case Report Bilateral Gluteal Pyomyositis and Multiple Sinus Tracts after Pentazocine Injection

Pentazocine has been one of the commonly abused injectable prescription opioids associated with dermatological complications. We present the case of a 43-year-old male who presented to us with bilateral gluteal pyomyositis and multiple sinus tracts as a consequence of pentazocine abuse. The patient had been given injectable pentazocine for relief of his migrainous headache by his local physician. He started to gradually take it in increased doses and became dependent. He developed seizures on increased use, but did not desist from taking injectable pentazocine. He shifted to intramuscular route when intravenous access became difficult, and started to inject in the buttocks and deltoid. Over time, he developed deep ulcers and sinuses, and had purulent discharge. MRI revealed extensive bilateral gluteal pyomyositis with cellulitis and abscess with multiple sinus tracts. His condition was managed conservatively with antibiotics and improvement was seen. This case highlights that in atypical cases, deep extensive sinuses affecting the muscle can develop due to pentazocine abuse, and a high index of suspicion is required (German J Psychiatry 2013; 16(4): 156-157).