Group A Streptococcus in an Unexpected Site

Background: Pyomyositis is an uncommon bacterial infection of skeletal muscle. Group A Streptococcus (GAS) accounts for a smaller proportion of pediatric cases, and temporal muscle involvement is exceptionally rare. Case Description: We report 2 previously healthy children, a 7-year-old boy and a 6-year-old girl, who presented with acute otitis media (AOM) and painful unilateral temporomandibular swelling. Computed tomography revealed AOM with temporal myositis, complicated by mastoiditis in the first case. Both were treated with intravenous antibiotics, and the first case required drainage and mastoidectomy, with full recovery. GAS was isolated in both cases. Conclusions: GAS temporal pyomyositis should be considered in children presenting with AOM and painful temporal swelling. Imaging is crucial for diagnosis and assessment of disease extent. Surgical management should be individualized.