Twelve cases of pyomyositis treated at a rural tertiary care referral center are reported and compared to other published cases of this disorder in the United States. About 350 cases have been reported nationally and over a quarter of them are in patients infected with human immunodeficiency virus (HIV). Pyomyositis, classically a disease of the healthy young male, starts insidiously and progresses to a pus filled abscess of a muscle or a group of muscles. It is a clinical diagnosis often misdiagnosed and therefore treatment is delayed. Imaging studies are conclusive in most cases by the time of presentation. Our series has a predominance of older females, no HIV positive patients and is unique in comparison to previously reported trends and cases.