Primary obturator-muscle pyomyositis in immunocompetent children

García-Mata, Serafín; Hidalgo-Ovejero, Ángel; Esparza-Estaun, Joaquín

doi:10.1007/s11832-012-0418-y

Cited by 14 publications

(15 citation statements)

References 43 publications

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“…In this review of literature (Table 1 ), methicillin-sensitive Staphylococcus aureus is the most often reported causative organism for pelvic pyomyositis in children (80%). [ 2 , 4 , 11 , 12 , 15 – 25 , 27 , 29 – 31 ] Methicillin-resistant Staphylococcus aureus (11.5%) [ 9 , 11 , 23 , 30 ] or Streptococcus group A (6.5%) [ 11 , 28 , 29 ] have also been implicated. However, Pannaraj et al [ 3 ] report the emergence of methicillin-resistant Staphylococcus aureus in pediatric musculoskeletal infections, especially in the United States, since 2000.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

“…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%

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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%

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Obturator externus abscess in a 9-year-old child

et al. 2017

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“…MRI is the gold standard method for imaging. 9 The causal relationship between OM and PM is difficult to resolve, especially when the two conditions appear to occur simultaneously as in our second case. OM is usually considered a complication of PM, but in most cases, both of them probably represent simultaneous manifestations of the same bacteremia.…”

Section: Discussionmentioning

confidence: 77%

“…3 Laboratory tests may reveal high ESR and CRP, which are the most sensitive and helpful laboratory parameters in monitoring the disease course and its response to treatment. 9 Leukocytosis always develops 12 to 24 hours later. CPK level is usually normal while serum aldolase may be increased as in our cases.…”

Section: Discussionmentioning

confidence: 99%

Primary Pyomyositis as Unusual Cause of Limp: Three Cases in Immunocompetent Children and Literature Review

Drovandi

Trapani

Richichi

et al. 2017

J Pediatr Infect Dis

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Pyomyositis (PM) is an uncommon primary skeletal muscle infection caused mainly by Staphylococcus aureus that is characterized by single or multiple intramuscular abscess formation. In our ward, between 2013 and 2015, three children (two females and one male) aged from 2 to 12 years were diagnosed and treated for PM. Patients' medical records and imaging studies were examined retrospectively. All patients, otherwise healthy, complained of limp, fever, and severe lower limb pain. Skin scratch lesions were detected in two cases; one of them showed an edematous appearance of the affected area. Multifocal bilateral abscesses of gemini and gastrocnemius were detected in the youngest patient; right obturator and iliac muscles were affected in the second patient; and right gluteus and pyriform muscles were involved in the third patient. All patients showed elevated acute phase reactants and had normal serum creatinine kinase levels. Blood cultures and polymerase chain reaction (PCR) investigations were negative in all cases. Magnetic resonance imaging (MRI) findings included muscle enlargement, deep fascia, high signal in subcutaneous tissues, and postgadolinium abscess formation. No patient required surgical or percutaneous drainage. All three were treated conservatively with intravenous oxacillin, associated with ceftriaxone in the first patient and ceftazidime in the other two, followed by oral antibiotic therapy for a period ranging from 5 to 6 weeks. Pyomyositis must be considered as an unusual cause of limp in children of all ages. When promptly diagnosed and adequately treated, it has a favorable outcome without relapses or sequelae as occurred in all our patients.

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“…When pyomyositis involves the muscles of the pelvis, pain is usually transferred to the hip. Pelvic pyomyositis initially originates from the anterolateral and posterolateral walls of the pelvic cavity and surrounds the obturator foramen, ending in a tendinous band across the posterior capsule of the hip involving deep pelvic muscles like psoas, iliacus, piriformis and obturators [38]. One study from the USA showed high proportion of cases of pericapsular pyomyositis (32 %) among 53 children, initially referred as cases of septic arthritis/irritable hip joint [39•].…”

Section: Clinical Presentationmentioning

confidence: 99%

Pyomyositis in Children

Verma

2016

Curr Infect Dis Rep

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Primary pyomyositis in children is prevalent in the tropics and increasingly being recognised from temperate regions. Staphylococcus aureus remains the principle causative organism worldwide, while proportion of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is on rise. Commonly involved groups are around the pelvis and lower limbs. Clinical presentation depends on the stage of disease, most commonly a child presenting with limping with fever. Early diagnosis and management are crucial. The investigation of choice is MRI scan. Appropriate antibiotic treatment should be instituted at the earliest opportunity along with drainage. Majority of patients show excellent and complete recovery with no long-term complications once treatment is started early. A high level of awareness and suspicion of this condition is warranted from all paediatric clinicians.

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Primary obturator-muscle pyomyositis in immunocompetent children

Cited by 14 publications

References 43 publications

Obturator externus abscess in a 9-year-old child

Obturator externus abscess in a 9-year-old child

Primary Pyomyositis as Unusual Cause of Limp: Three Cases in Immunocompetent Children and Literature Review

Pyomyositis in Children

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