Primary obturator internus and obturator externus pyomyositis

Khoshhal, Khalid I.; Abdelmotaal, Hamdy M.; AlArabi, Rayan

doi:10.12659/ajcr.883871

Cited by 16 publications

(7 citation statements)

References 23 publications

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“…In 80% of cases, blood cultures are usually sufficient to identify the pathogen. [ 2 , 9 – 12 , 15 – 17 , 19 – 25 , 27 – 30 ] In cases of negative blood cultures, classical isolation methods yield to pathogen identification in abscess specimens most of the time (22.5%). [ 4 , 11 , 23 , 25 , 30 , 31 ]…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Obturator externus abscess in a 9-year-old child

et al. 2017

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Rationale:Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis. Additionally, joint fluid aspirations and blood cultures are also useful in identifying the pathogen. The appropriate antibiotic therapy provides a rapid regression of symptoms during the early stage of pyomyositis. In cases of MRI-confirmed abscess, surgical treatment is indicated.Patient concerns:Our report focuses on a case of obturator pyomyositis in a 9-year-old boy. The child was febrile for 5 days and could only manage to walk a few steps. His hip range of motion was restricted in all directions. In addition, the patient had presented pain and swelling of his right elbow for a day, with a restriction of motion in the joint. There was a clear inflammatory syndrome. A diagnosis of hip and elbow septic arthritis was suspected, and the child underwent joint aspiration of the both cited joints. The aspiration of the elbow returned pus. Conversely, no effusion was found in the hip aspiration. The administration of empiric intravenous antibiotherapy was started.Diagnoses:An MRI revealed an osteomyelitis of the ischio-pubic area associated with a subperiosteal abscess.Interventions:Subsequently, 3 days after elbow arthrotomy, a surgical treatment was performed on the patient's right hip in order to evacuate the subperiosteal abscess and muscular collection because of the persistence of the patient's symptoms and inflammatory syndrome despite susceptible intravenous antibiotics. Postsurgery the patient showed steady improvement.Lessons:Such cases demonstrate how diagnosis can be difficult because pelvic pyomyositis is often mistaken for more common pathologies such as septic arthritis, osteomyelitis, or appendicitis. This may delay the diagnosis or refer misdiagnosis. We discuss this rare infection in light of the literature with particular reference to its incidence, clinical features, bacteriological etiology, biological, and radiological presentation, and above all, its treatment.

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Section: Discussion and Review Of Literaturementioning

confidence: 99%

Obturator externus abscess in a 9-year-old child

et al. 2017

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“…Primary pyomyositis is common in many parts of Africa and in the South Pacific, and has earned the name “tropical pyomyositis.” It occurs more frequently in immune-compromised patients, though it can be related to factors affecting the muscle itself (strenuous exercise, direct muscle trauma, viral or parasitic myositis) [4]. Secondary pyomyositis is usually a consequence of direct extension from an infectious process, most notably Crohn’s disease, infectious colitis, appendicitis, and neoplasia.…”

Section: Introductionmentioning

confidence: 99%

Pyomyositis is not only a tropical pathology: a case series

et al. 2016

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Background: Pyomyositis is an acute bacterial infection of skeletal muscle that results in localized abscess formation. This infection was thought to be endemic to tropical countries, and is also known as "tropical pyomyositis". However, pyomyositis is increasingly recognized in temperate climates and is frequently associated with an immunosuppressive condition, such as human immunodeficiency virus, malignancy, and diabetes mellitus. It is also found in healthy and athletic people after strenuous or vigorous exercise or following localized and possibly unnoticed trauma. It can be primary or secondary to neighboring or remote infection. Primary pyomyositis is a rare condition that can affect children and adolescents. Diagnosis can be delayed because the affected muscle is deeply situated and local signs are not apparent. This delay in diagnosis can result in increased morbidity and a significant mortality rate. The pediatric population, which comprises 35% of the reported pyomyositis cases, is an especially difficult subset of patients to diagnose. Case presentation: In our series, we describe the cases of four previously healthy Caucasian children who were admitted to our Pediatric Department with different clinical presentations. Pyomyositis in our patients was related to factors affecting the muscle itself, including strenuous exercise and direct muscle trauma. Therapy was started with a cephalosporin antibiotic and teicoplanin was subsequently added. The minimum length of therapy was 3 weeks. Conclusions: The diagnosis of pyomyositis in our patients, none of whom were immune-compromised, is confirmation that this disease is not an exclusive pathology of tropical countries and demonstrates that there is an increasing prevalence of pyomyositis in temperate climates.

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“…Because of its rarity and often non-specific symptoms, OIM abscess is unlikely to be considered during initial diagnosis. Delay in diagnosis may result in severe complications, such as extension into and destruction of an adjacent joint, compartment syndrome, solid-organ impairment, sepsis, and even death [ [5] , [6] ].…”

Section: Discussionmentioning

confidence: 99%

“…Although rare, an increasing number of cases have occurred in temperate climates [ 11 ]. Because of its rarity, diagnosis is often delayed, leading to severe complications and prolonged therapy [ [5] , [6] ]. In past reports of OIM abscess, there are only five adult cases.…”

Section: Introductionmentioning

confidence: 99%