Pyomyositis

CORRESPONDENCE

Sir,

I read with interest the case report by Peckett et al1 in the January 2001 issue entitled 'Pyomyositis of the iliacus muscle in a child'.

Recently, a nine-year-old girl presented to us as a case of possible septic arthritis of the hip. With further investigations including MRI, the diagnosis proved to be pyomyositis. Ultrasound of the hip was negative and the blood parameters suggested acute infection. The positive blood cultures and appropriate systemic antibiotics gave resolution of the symptoms in five days.

As suggested by the reports of Peckett et al,1 Macnicol 2 and Papadopoulos et al,3 we endorse the use of MRI for the early definitive diagnosis of suspected infection around the hip or the pelvis. Pyomyositis appears to be increasing in prevalence in temperate climates. Orthopaedic surgeons are usually involved in the initial decision-making and ultimate care of these patients. The diagnosis is often delayed because of lack of familiarity and the paucity of symptoms on initial evaluation. Other primary diagnoses usually considered included muscle strain, synovitis, early Perthes' disease, thrombophlebitis and neoplasm thus contributing to the diagnostic delay. Pyomyositis of the obturator internus,3 adductor,4 and psoas5 giving similar doagnostic confusion has also been reported.

MRI confirms whether the inflammatory process is localised to the muscle or is secondary to an infection in the bone.2

M. B. RAJESH, FRCS Kent & Canterbury Hospital Canterbury, UK.

Authors' reply:

Sir,

We were interested to learn that Mr Rajesh has had a similar case of pyomyositis around the hip in a child of the same age. He confirms the value of MRI in the investigation of such cases which allowed early diagnosis and resolution of the condition with appropriate systemic antibiotic treatment.

It may well be that pyomyositis is increasing in prevalence in temperate climates and we believe that it is important therefore that orthopaedic surgeons are aware of this differential diagnosis which we have shown can readily be diagnosed in its early stages by MRI.

We suspect that before the availability of MRI similar cases probably progressed to the formation of an abscess around the hip which required surgical drainage leading to increased morbidity. With greater clinical awareness of this condition and more readily available MRI pyomyositis will be detected at an early stage eliminating the need for surgical treatment.

W. R. C. PECKETT, FRCS

A. BUTLER-MANUEL, FRCS

L. A. APTHORP, FRCR

Conquest Hospital St Leonards-on-Sea, UK.

1. Peckett WRC, Butler-Manuel A, Apthorp LA. Pyomyositis of the iliacus muscle in a child. J Bone Joint Surg [BrI 2001;83-B: 103-5.

2. Macnicol MF. Editorial. Patterns of musculoskeletal infection in childhood. J Bone Joint Surg [Br] 2001;83-B:1-2.

3. Papadopoulos M, Chugh S, Fitzgerald R, Thomas RJ. Obturator internus pyomyositis. Orthopaedics 2000;23:383-4.

4. De Boeck H, Noppen L, Desprechins B. Pyomyositis of the adductor muscles mimicking an infection of the hip: diagnosis by magnetic resonance imaging: a case report. J Bone Joint Surg [Am] 1994;76-A:747-50.

5. Perry J, Barrack RL, Burke SW, Haddad RJ. Psoas abscess mimicking a septic hip: diagnosis by computed tomography. J Bone Joint Surg [Am] 1985;67-A:1281-3.

Copyright British Editorial Society of Bone & Joint Surgery Sep 2002
Provided by ProQuest Information and Learning Company. All rights Reserved