Pyomyositis is a purulent infection involving the skeletal musclesas a result of haematogenous spread. Escherichia coli (E. coli) is a rare cause for pyomyositis and previous published case reports mainly involved immunocompromised patients with haematological malignancies. We present a case of a 42-year-old immunocompetent female with confirmed E. coli urosepsiscomplicated by development of stage 1 pyomyositis. Early detection is essential where pyomyositis should still be suspected as a differential diagnosis in immunocompetent patients with confirmed E. coli bacteraemia with signs of suspected localised muscle infection.