Obturator Externus Pyomyositis

Slade, Timothy; Hawkes, Rob; Atherton, Guy; Sargant, N

doi:10.1097/pec.0000000000000212

Pediatric Emergency Care

2014

DOI: 10.1097/pec.0000000000000212

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Obturator Externus Pyomyositis

Timothy Slade

Rob Hawkes²,

Guy Atherton³

et al.

Abstract: Pyomyositis of the obturator externus muscle is a rare cause of limp and hip pain in children. The exact etiology of the condition remains poorly understood, although a mechanism of transient bacteremia in association with increased muscle susceptibility has been proposed. This case describes the course of a rather than 1 child from presentation to diagnosis and demonstrates the requirement for magnetic resonance imaging in establishing a diagnosis.

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Cited by 3 publications

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Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis

Hsu

Hsu²,

Chen³

et al. 2016

Medicine

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Pyomyositis is a pyogenic infection of the skeletal muscles causing myalgia and fever in patients. Hematogenous seeding engendered by persistent bacteremia and septic embolism is usually the underlying cause of the disease. Trauma, intravenous drug use, and immunodeficiency are the main predisposing factors.Obturator internus pyomyositis with sciatica has not previously been reported. We report a rare case of a patient with subacute bacterial endocarditis presenting with left buttock pain and sciatica.Computed tomography confirmed the diagnosis of obturator internus pyomyositis. The patient was discharged uneventfully after successful antibiotic treatment.The mortality rate of patients who have pyomyositis comorbid with another condition or disease is extremely high. Early diagnosis and aggressive management are imperative.

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Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis

Hsu

Hsu²,

Chen³

et al. 2016

Medicine

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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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Leg Pain in a 10-year-old Girl

Pallos,

Antony,

Kojaoghlanian

2024

Pediatrics in Review

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Obturator Externus Pyomyositis

Cited by 3 publications

References 5 publications

Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis

Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis

Obturator externus abscess in a 9-year-old child

Leg Pain in a 10-year-old Girl

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