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Pyomyositis of the pectineus muscle in an adolescent male.

Abstract The 'irritable hip' continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.
PMID
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Authors

Mayor MeshTerms

Thigh

Keywords

Irritable hip

Pectineus

Pyomyositis

Journal Title annals of the royal college of surgeons of england
Publication Year Start




PMID- 28853599
OWN - NLM
STAT- MEDLINE
DA  - 20170830
DCOM- 20170913
LR  - 20170913
IS  - 1478-7083 (Electronic)
IS  - 0035-8843 (Linking)
VI  - 99
IP  - 7
DP  - 2017 Sep
TI  - Pyomyositis of the pectineus muscle in an adolescent male.
PG  - e216-e218
LID - 10.1308/rcsann.2017.0142 [doi]
AB  - The 'irritable hip' continues to pose a challenge for clinicians. Even with
      predictive clinical algorithms, decision making can be difficult. Emergency
      treatment is required if septic arthritis is suspected. Other differential
      diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles
      and osteomyelitis must be considered in order to help guide appropriate
      investigations and allow early treatment. We report the case of a 13-year-old boy
      presenting to our institution with an acutely painful left hip but still able to 
      weight bear. Despite a fever and raised inflammatory markers, the clinical
      examination did not correspond to that of an infected hip joint. Urgent magnetic 
      resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our
      knowledge, this is the first reported case in the literature. The child was
      treated with seven days of intravenous antibiotics. There was a good clinical
      response as well as normalisation of the C-reactive protein level and white cell 
      count. The patient was discharged home with a further week of oral antibiotics.
      Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation 
      of the pectineus. At the clinic follow-up appointment, the child was asymptomatic
      and back to normal function. Pyomyositis is typically found in tropical areas but
      its rates in temperate climates have been rising. It usually affects large groups
      of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard
      investigation. If diagnosed early, the condition can be treated successfully with
      intravenous antibiotics alone. Given the widespread availability of MRI, we
      recommend its increased use to distinguish between pyomyositis and other
      paediatric hip pathologies.
FAU - Hiddema, J
AU  - Hiddema J
AD  - Kingston Hospital NHS Foundation Trust , UK.
FAU - Hassan, S
AU  - Hassan S
AD  - Kingston Hospital NHS Foundation Trust , UK.
FAU - Mangat, N
AU  - Mangat N
AD  - Kingston Hospital NHS Foundation Trust , UK.
FAU - Siddiqui, N
AU  - Siddiqui N
AD  - Kingston Hospital NHS Foundation Trust , UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Ann R Coll Surg Engl
JT  - Annals of the Royal College of Surgeons of England
JID - 7506860
RN  - 0 (Anti-Bacterial Agents)
RN  - 75J73V1629 (Ceftriaxone)
SB  - IM
MH  - Adolescent
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Ceftriaxone/therapeutic use
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Muscle, Skeletal/diagnostic imaging
MH  - Pyomyositis/*diagnosis/diagnostic imaging/drug therapy
MH  - *Thigh/diagnostic imaging
OTO - NOTNLM
OT  - Irritable hip
OT  - Pectineus
OT  - Pyomyositis
EDAT- 2017/08/31 06:00
MHDA- 2017/09/14 06:00
CRDT- 2017/08/31 06:00
AID - 10.1308/rcsann.2017.0142 [doi]
PST - ppublish
SO  - Ann R Coll Surg Engl. 2017 Sep;99(7):e216-e218. doi: 10.1308/rcsann.2017.0142.