eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2016-10-27 4 9 319 320 10.12691/ajmcr-4-9-7 AJMCR2016497 article Ines Kechaou kechaou.ines@topnet.tn 1 Eya Cherif 1 Imene Boukhris 1 Samira Azzabi 1 Lamia Ben Hassine 1 Narjes Khalfallah 1 Internal Medicine Department, University hospital of Charles Nicolle, Tunis, Tunisia Pyomyositis is a severe infectious complication reported in diabetic patients. A double noncontiguous location of this complication is exceptional. We report a case of a 58-year-old woman, who presented with a painful swelling left thigh and arm. The diagnosis of bifocal pyomyositis in the left vastusintermedius quadriceps and in the triceps muscle of the left arm was made on MRI findings. The causative agent was not isolated because of preceding antibiotic use. In this observation diabetes mellitus constitute the aim predisposing factor revealing pyomyositis by ketoacidosis. http://pubs.sciepub.com/ajmcr/4/9/7/ajmcr-4-9-7.pdf diabetes pyomyositis intramuscularabcess MRI ketoacidosis