Hip abductors pyomyositis: a case report and review of the literature

Abstract

Pyomyositis, an acute hematogenous intramuscular bacterial infection, is an unusual disease in temperate climates. We present the case of a 15-year-old girl who was referred to our centre with pain, fever, and limping. Magnetic resonance imaging and surgery showed diffuse pus collection in the hip abductor muscles. With increased incidence of this disease in immunocompromised patients in temperate areas, physicians must become familiar with its signs and symptoms to facilitate early diagnosis.

Hip adductor pyomyositis from Streptococcus mitis in a four-year-old child

“…Previously pyomyositis of the adductor muscle have been reported in a child the age of 8 9 and Hasemi et al reported pyomyositis in the hip abductors of a 15-year-old girl. 2 Chen et al reported the occurrence of bilateral hip adductors in a 17-year-old child suffering from chronic myeloid leukaemia. 1 But none were due to a S. mitis infection.…”

“…The most common causative organism of primary pyomyositis is Staphylococcus aureus, 1,6-8 followed by Beta Haemolytic Group A Streptococcus, 2,3,7 Escherichia coli, 2,3,7 Neisseria gonorrhoeae 2,8 and Streptococcus pyogenes. 2,8 S. mitis is a commensal bacteria that normally resides in the oropharynx, upper respiratory tract, skin, gastrointestinal and the urogenital tracts. 10 S. mitis is a member of the viridians group of streptococcus that are gram positive, catalase negative, form chains upon microscopic inspection and are an alpha hemolytic strain.…”

“…Images can reveal anatomical site, extent of disease and stage of illness. 2,3 Furthermore, MRI also aids to rule out other differential diagnosis, early diagnosis can help to avoid unnecessary surgical intervention or assist with it when required. 7 Treatment recommendation depends on the stage of infection.…”

“…7 Treatment recommendation depends on the stage of infection. [1][2][3][4][5] When diagnosed at the early diffuse inflammatory phase these infections respond well to conservative antibiotic treatment 7 and may negate the need for surgical debridement and drainage. 8 Systemic aggressive antibiotic treatment should be continued regardless of surgical input, to prevent further dissemination of the infection until symptoms clear.…”

“…Primary pyomyositis is a rare deep subacute haematogenous intramuscular pyogenic infection of striated skeletal muscle, not secondary to contagious infection from adjacent skin, bone, soft tissue, neighbouring tissue or direct penetrating injury. [1][2][3][4][5][6][7] Pyomyositis is endemically seen in countries with a tropical climate. 3,4 Cases of pyomyositis was seen rarely in temperate countries but has shown an emerging incidence.…”