Primary Infective Pyomyositis of the Hip Abductors Presenting as Trochanteric Bursitis

Author Info

Curtin PD Gerard A. Sheridan Heffernan EJ Johnson DP

Corresponding Author

Gerard A. Sheridan
Department of Orthopaedics, St. Vincent’s University Hospital, Dublin

A B S T R A C T

Introduction: Pyomyositis is an uncommon suppurative infection of skeletal muscle. In recent times, it is becoming more prevalent in the context of immunosuppression and diabetes and it is known to show a preponderance for pelvic girdle muscles. We present a case of a primary infective pyomyositis of the gluteal musculature in a diabetic patient which presented initially as a typical greater trochanteric bursitis. Case Report: A 52 year old female presented with sudden onset left lateral thigh pain localized to the greater trochanteric region. Relevant comorbidities included a BMI of 35, uncontrolled non insulindependent diabetes mellitus and hypertension. Her HbA1c on presentation was 97mmol/mol. She had a raised CRP of 92 with a normal white cell count. MRI confirmed an ill-defined collection overlying the gluteal tendon insertions with extensive surrounding oedema. The patient was surgically managed and underwent incision and drainage through a direct lateral incision. Samples sent were positive for staphylococcus aureus and the patient was commenced on IV flucloxacillin. They progressed to a full recovery. Conclusion: We recommend that consideration be given to infective pyomyositis in the differential for patients presenting acutely with trochanteric hip pain. Pyrexia, raised inflammatory markers and a history of diabetes mellitus or other immunosuppressive conditions should raise clinical suspicion for occult infection even in the setting of a common clinical complaint such as trochanteric hip pain. MRI is essential in achieving early diagnosis and surgical drainage and medical management can lead to a good clinical recovery.

Article Info

Article Type

Case Report

Publication history

Received: Wed 12, Jun 2019
Accepted: Mon 24, Jun 2019
Published: Wed 03, Jul 2019

Copyright

© 2023 Gerard A. Sheridan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2019.03.14